FHIR IG Statistics: Measure/CMS122FHIRDiabetesAssessGreaterThan9Percent

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define "Initial Population":   AgeInYearsAt(date from      end of "Measurement Period"   ) in Interval[18, 75]     and exists "Qualifying Encounters"     and exists ( ( ( [ConditionEncounterDiagnosis: "Diabetes"] ).verified ( ) ) DiabetesDiagnosis         where DiabetesDiagnosis.prevalenceInterval ( ) overlaps day of "Measurement Period"     )

define "Denominator":   "Initial Population"

define "Denominator Exclusions":   Hospice."Has Hospice Services"     or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home"     or AIFrailLTCF."Is Age 66 or Older with Advanced Illness and Frailty"     or PalliativeCare."Has Palliative Care in the Measurement Period"

define "Numerator":   "Has Most Recent Glycemic Status Assessment Without Result"     or "Has Most Recent Elevated Glycemic Status Assessment"     or "Has No Record Of Glycemic Status Assessment"

define "Has Hospice Services":   exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter       where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"           or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"       )         and InpatientEncounter.period ends during day of "Measurement Period"   )     or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter         where HospiceEncounter.period overlaps day of "Measurement Period"     )     or exists ((([ObservationScreeningAssessment: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment         where HospiceAssessment.value ~ "Yes (qualifier value)"           and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"     )     or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder         where HospiceOrder.authoredOn during day of "Measurement Period"     )     or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed         where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"     )     or exists ((([ConditionProblemsHealthConcerns: "Hospice Diagnosis"]         union [ConditionEncounterDiagnosis: "Hospice Diagnosis"]).verified()) HospiceCareDiagnosis         where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"     )

define "Is Age 66 or Older Living Long Term in a Nursing Home":   AgeInYearsAt(date from       end of "Measurement Period"   )>= 66     and ( ( Last( (([ObservationScreeningAssessment: "Housing status"]).isAssessmentPerformed()) HousingStatus               where HousingStatus.effective.toInterval() ends on or before            day of end of "Measurement Period"           sort by            end of effective.toInterval() asc       )) LastHousingStatus         where LastHousingStatus.value ~ "Lives in nursing home (finding)"     ) is not null

define "Has Criteria Indicating Frailty":   exists ( (([DeviceRequest: "Frailty Device"]).isDeviceOrderPersonalUseDevices()) FrailtyDeviceOrder       where FrailtyDeviceOrder.authoredOn.toInterval() during day of "Measurement Period"   )     or exists ( (([ObservationScreeningAssessment: "Medical equipment used"]).isAssessmentPerformed()) EquipmentUsed         where EquipmentUsed.value as Concept in "Frailty Device"          and EquipmentUsed.effective.toInterval() ends during day of "Measurement Period"     )     or exists ( (([ConditionProblemsHealthConcerns: "Frailty Diagnosis"]     union [ConditionEncounterDiagnosis: "Frailty Diagnosis"]).verified()) FrailtyDiagnosis         where FrailtyDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"     )     or exists ( (([Encounter: "Frailty Encounter"]).isEncounterPerformed()) FrailtyEncounter         where FrailtyEncounter.period overlaps day of "Measurement Period"     )     or exists ( (([SimpleObservation: "Frailty Symptom"]).isSymptom()) FrailtySymptom         where FrailtySymptom.effective.toInterval() overlaps day of "Measurement Period"     )

define "Has Advanced Illness in Year Before or During Measurement Period": exists ((([ConditionProblemsHealthConcerns: "Advanced Illness"] union [ConditionEncounterDiagnosis: "Advanced Illness"]).verified()) AdvancedIllnessDiagnosis where AdvancedIllnessDiagnosis.prevalenceInterval() starts during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"])

define "Has Dementia Medications in Year Before or During Measurement Period":   exists (( ([MedicationRequest: "Dementia Medications"]).isMedicationActive()) DementiaMedication       where DementiaMedication.medicationRequestPeriod() overlaps day of Interval[start of "Measurement Period" - 1 year,          end of "Measurement Period"]   )

define "Is Age 66 or Older with Advanced Illness and Frailty":    AgeInYearsAt(date from end of "Measurement Period")>= 66     and "Has Criteria Indicating Frailty"     and ( "Has Advanced Illness in Year Before or During Measurement Period"         or "Has Dementia Medications in Year Before or During Measurement Period"     )

define "Has Palliative Care in the Measurement Period":   exists ((([ObservationScreeningAssessment: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment       where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period"   )     or exists ((([ConditionProblemsHealthConcerns: "Palliative Care Diagnosis"]     union [ConditionEncounterDiagnosis: "Palliative Care Diagnosis"]).verified()) PalliativeDiagnosis         where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"     )     or exists ((([Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter         where PalliativeEncounter.period overlaps day of "Measurement Period"     )     or exists ((([Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention         where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period"     )

define "SDE Sex":   case     when Patient.sex = '248153007' then "Male (finding)"     when Patient.sex = '248152002' then "Female (finding)"     else null   end

define "SDE Payer":   [Coverage: type in "Payer Type"] Payer     return {       code: Payer.type,       period: Payer.period     }

define "SDE Ethnicity":   Patient.ethnicity E     return Tuple {       codes: { E.ombCategory } union E.detailed,       display: E.text     }

define "SDE Race":   Patient.race R     return Tuple {       codes: R.ombCategory union R.detailed,       display: R.text     }

define "SDE Sex":   SDE."SDE Sex"

define "Glycemic Status Assessment":   ( ( [LaboratoryResultObservation: "HbA1c Laboratory Test"]       union [LaboratoryResultObservation: "Glucose management indicator"]   ).isLaboratoryTestPerformed ( ) ) GlycemicStatus     where GlycemicStatus.effective.latest ( ) during day of "Measurement Period"

define "Most Recent Glycemic Status Date":   Last(("Glycemic Status Assessment" QualifyingGlycemicStatus       return date from QualifyingGlycemicStatus.effective.latest()) QualifyingGlycemicStatus       sort asc   )

define "Lowest Glycemic Status Assessment Reading on Most Recent Day":   First("Glycemic Status Assessment" QualifyingGlycemicStatus       where QualifyingGlycemicStatus.effective.latest() same day as "Most Recent Glycemic Status Date"       return {         QualifyingGlycemicStatusValue: QualifyingGlycemicStatus.value as Quantity,         QualifyingGlycemicStatus: QualifyingGlycemicStatus       }       sort by QualifyingGlycemicStatusValue   ).QualifyingGlycemicStatus

define "Has Most Recent Glycemic Status Assessment Without Result":   "Lowest Glycemic Status Assessment Reading on Most Recent Day" is not null     and "Lowest Glycemic Status Assessment Reading on Most Recent Day".value is null

define "Has Most Recent Elevated Glycemic Status Assessment":   "Lowest Glycemic Status Assessment Reading on Most Recent Day".value > 9 '%'

define "Has No Record Of Glycemic Status Assessment":   not exists "Glycemic Status Assessment"

define "Numerator":   "Has Most Recent Glycemic Status Assessment Without Result"     or "Has Most Recent Elevated Glycemic Status Assessment"     or "Has No Record Of Glycemic Status Assessment"

define "Qualifying Encounters":   ( ( [Encounter: "Office Visit"]       union [Encounter: "Annual Wellness Visit"]       union [Encounter: "Preventive Care Services Established Office Visit, 18 and Up"]       union [Encounter: "Preventive Care Services Initial Office Visit, 18 and Up"]       union [Encounter: "Home Healthcare Services"]       union [Encounter: "Nutrition Services"]       union ( [Encounter] E           where exists ( ( E.type ) T               where T ~ "Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes"           )       )       union ( [Encounter] E           where exists ( ( E.type ) T               where T ~ "Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes"           )       )       union ( [Encounter] E           where exists ( ( E.type ) T               where T ~ "Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes"           )       )       union ( [Encounter] E           where exists ( ( E.type ) T               where T ~ "Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes"           )       )       union ( [Encounter] E           where exists ( ( E.type ) T               where T ~ "Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes"           )       )       union [Encounter: "Telephone Visits"]   ).isEncounterPerformed ( ) ) ValidEncounters     where ValidEncounters.period during day of "Measurement Period"

define "Initial Population":   AgeInYearsAt(date from      end of "Measurement Period"   ) in Interval[18, 75]     and exists "Qualifying Encounters"     and exists ( ( ( [ConditionEncounterDiagnosis: "Diabetes"] ).verified ( ) ) DiabetesDiagnosis         where DiabetesDiagnosis.prevalenceInterval ( ) overlaps day of "Measurement Period"     )

define "Denominator":   "Initial Population"

define "SDE Payer":   SDE."SDE Payer"

define "SDE Ethnicity":   SDE."SDE Ethnicity"

define "Denominator Exclusions":   Hospice."Has Hospice Services"     or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home"     or AIFrailLTCF."Is Age 66 or Older with Advanced Illness and Frailty"     or PalliativeCare."Has Palliative Care in the Measurement Period"

define "SDE Race":   SDE."SDE Race"

define function ToString(value uri): value.value

/* @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept. */ define function ToConcept(concept FHIR.CodeableConcept):     if concept is null then         null     else         System.Concept {             codes: concept.coding C return ToCode(C),             display: concept.text.value         }

/* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding):     if coding is null then         null     else         System.Code {           code: coding.code.value,           system: coding.system.value,           version: coding.version.value,           display: coding.display.value         }

/* @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period) value to a CQL DateTime Interval @comment: If the start value of the given period is unspecified, the starting boundary of the resulting interval will be open (meaning the start of the interval is unknown, as opposed to interpreted as the beginning of time). */ define function ToInterval(period FHIR.Period):     if period is null then         null     else         if period."start" is null then             Interval(period."start".value, period."end".value]         else             Interval[period."start".value, period."end".value]

/* @description: Given an interval, returns the ending point if the interval has an ending boundary specified, otherwise, returns the starting point */ define fluent function latest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):   (choice.toInterval()) period     return       if (period."hasEnd"()) then end of period       else start of period

/* @description: Given an interval, returns true if the interval has an ending boundary specified (i.e. the end of the interval is not null and not the maximum DateTime value) */ define fluent function hasEnd(period Interval<DateTime> ):   not (     end of period is null       or end of period = maximum DateTime   )

/* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in QICore, allowing this function to be used across any resource. The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime. If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age, and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later. If the input is a DateTime Interval, the result is the input. If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending immediately before one year later than the date the patient turned the age given as the end of the quantity interval. If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval */ define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):   case    when choice is DateTime then      Interval[choice as DateTime, choice as DateTime]   when choice is Interval<DateTime> then     choice as Interval<DateTime>   when choice is Quantity then     Interval[Patient.birthDate + (choice as Quantity),      Patient.birthDate + (choice as Quantity) + 1 year)   when choice is Interval<Quantity> then     Interval[Patient.birthDate + (choice.low as Quantity),      Patient.birthDate + (choice.high as Quantity) + 1 year)   when choice is Timing then       Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>   else    null as Interval<DateTime>  end

//Laboratory Test, Performed define fluent function isLaboratoryTestPerformed(Obs List<LaboratoryResultObservation>):   Obs O     where O.status in { 'final', 'amended', 'corrected' }

//Encounter, Performed //General usage unless required otherwise by measure intent (e.g., follow-up encounters) define fluent function isEncounterPerformed(Enc List<Encounter>):   Enc E     where E.status = 'finished'

//This library contains functions used to constrain FHIR resource elements for measures authored by NCQA, based on QICore 6.0.0 resources including IG and authoring patterns. The functions may appear similar to some QICoreCommon functions but differ in that they have constraints that are relevant for measures authored by NCQA.  //Condition //Returns conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential define fluent function verified(conditions List<Choice<ConditionProblemsHealthConcerns, ConditionEncounterDiagnosis>>):   conditions C     where C.verificationStatus is not null implies       (C.verificationStatus ~ "confirmed"         or C.verificationStatus ~ "unconfirmed"         or C.verificationStatus ~ "provisional"         or C.verificationStatus ~ "differential"       )

//Assessment, Performed define fluent function isAssessmentPerformed(Obs List<ObservationScreeningAssessment>):   Obs O     where O.status in { 'final', 'amended', 'corrected' }

//Intervention, Order define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):   ServiceRequest S     where S.status in { 'active', 'completed' }       and S.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}

//Intervention, Performed define fluent function isInterventionPerformed(Proc List<Procedure>):   Proc P     where P.status ~ 'completed'

//Device, Order - Personal Use Devices define fluent function isDeviceOrderPersonalUseDevices(DeviceRequest List<DeviceRequest>):   DeviceRequest D     where D.status in { 'active', 'completed' }       and D.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}

//Symptom define fluent function isSymptom(Obs List<SimpleObservation>):   Obs O     where O.status in { 'preliminary', 'final', 'amended', 'corrected' }

//Medication, Active define fluent function isMedicationActive(MedicationRequest List<MedicationRequest>):   MedicationRequest M     where M.status = 'active'       and M.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}

define fluent function medicationRequestPeriod(Request "MedicationRequest"):   Request R     let       dosage: singleton from R.dosageInstruction,       doseAndRate: singleton from dosage.doseAndRate,       timing: dosage.timing,       frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),       period: Quantity(timing.repeat.period, timing.repeat.periodUnit),       doseRange: doseAndRate.dose,       doseQuantity: doseAndRate.dose,       dose: Coalesce(end of doseRange, doseQuantity),       dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),       boundsPeriod: timing.repeat.bounds as Interval<DateTime>,       daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value,       quantity: R.dispenseRequest.quantity,       refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),       startDate:         Coalesce(           date from start of boundsPeriod,           date from R.authoredOn,           date from start of R.dispenseRequest.validityPeriod         ),       totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)     return       if startDate is not null and totalDaysSupplied is not null then         Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]       else if startDate is not null and boundsPeriod."high" is not null then         Interval[startDate, date from end of boundsPeriod]       else         null

/**********************************************************************/ /* Functions in this region are copied from opioid-mme-r4             */ /**********************************************************************/  define function Quantity(value Decimal, unit String):   if value is not null then     System.Quantity { value: value, unit: unit }   else     null

/*  Goal is to get to number of days  Two broad approaches to the calculation:   1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered   2) Based on relevant period, determine a covered interval and calculate the length of that interval in days This topic covers several use cases and illustrates how to calculate Cumulative Medication Duration for each type of medication resource using the supply and frequency approach. */  /*   For the first approach, we need to get from frequency to a frequency/day   So we define ToDaily */  /*   Calculates daily frequency given frequency within a period */ define function ToDaily(frequency System.Integer, period System.Quantity):   case period.unit     when 'h' then frequency * (24.0 / period.value)     when 'min' then frequency * (24.0 / period.value) * 60     when 's' then frequency * (24.0 / period.value) * 60 * 60     when 'd' then frequency * (24.0 / period.value) / 24     when 'wk' then frequency * (24.0 / period.value) / (24 * 7)     when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */     when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */     when 'hour' then frequency * (24.0 / period.value)     when 'minute' then frequency * (24.0 / period.value) * 60     when 'second' then frequency * (24.0 / period.value) * 60 * 60     when 'day' then frequency * (24.0 / period.value) / 24     when 'week' then frequency * (24.0 / period.value) / (24 * 7)     when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */     when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */     when 'hours' then frequency * (24.0 / period.value)     when 'minutes' then frequency * (24.0 / period.value) * 60     when 'seconds' then frequency * (24.0 / period.value) * 60 * 60     when 'days' then frequency * (24.0 / period.value) / 24     when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)     when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */     when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */     else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit)   end

Source

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            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":   case     when Patient.sex = '248153007' then \"Male (finding)\"     when Patient.sex = '248152002' then \"Female (finding)\"     else null   end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 0
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS122FHIRDiabetesAssessGreaterThan9Percent"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":   SDE.\"SDE Sex\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 1
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS122FHIRDiabetesAssessGreaterThan9Percent"
            },
            {
              "url": "name",
              "valueString": "Glycemic Status Assessment"
            },
            {
              "url": "statement",
              "valueString": "define \"Glycemic Status Assessment\":   ( ( [LaboratoryResultObservation: \"HbA1c Laboratory Test\"]       union [LaboratoryResultObservation: \"Glucose management indicator\"]   ).isLaboratoryTestPerformed ( ) ) GlycemicStatus     where GlycemicStatus.effective.latest ( ) during day of \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS122FHIRDiabetesAssessGreaterThan9Percent"
            },
            {
              "url": "name",
              "valueString": "Most Recent Glycemic Status Date"
            },
            {
              "url": "statement",
              "valueString": "define \"Most Recent Glycemic Status Date\":   Last((\"Glycemic Status Assessment\" QualifyingGlycemicStatus       return date from QualifyingGlycemicStatus.effective.latest()) QualifyingGlycemicStatus       sort asc   )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS122FHIRDiabetesAssessGreaterThan9Percent"
            },
            {
              "url": "name",
              "valueString": "Lowest Glycemic Status Assessment Reading on Most Recent Day"
            },
            {
              "url": "statement",
              "valueString": "define \"Lowest Glycemic Status Assessment Reading on Most Recent Day\":   First(\"Glycemic Status Assessment\" QualifyingGlycemicStatus       where QualifyingGlycemicStatus.effective.latest() same day as \"Most Recent Glycemic Status Date\"       return {         QualifyingGlycemicStatusValue: QualifyingGlycemicStatus.value as Quantity,         QualifyingGlycemicStatus: QualifyingGlycemicStatus       }       sort by QualifyingGlycemicStatusValue   ).QualifyingGlycemicStatus"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS122FHIRDiabetesAssessGreaterThan9Percent"
            },
            {
              "url": "name",
              "valueString": "Has Most Recent Glycemic Status Assessment Without Result"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Most Recent Glycemic Status Assessment Without Result\":   \"Lowest Glycemic Status Assessment Reading on Most Recent Day\" is not null     and \"Lowest Glycemic Status Assessment Reading on Most Recent Day\".value is null"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS122FHIRDiabetesAssessGreaterThan9Percent"
            },
            {
              "url": "name",
              "valueString": "Has Most Recent Elevated Glycemic Status Assessment"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Most Recent Elevated Glycemic Status Assessment\":   \"Lowest Glycemic Status Assessment Reading on Most Recent Day\".value > 9 '%'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS122FHIRDiabetesAssessGreaterThan9Percent"
            },
            {
              "url": "name",
              "valueString": "Has No Record Of Glycemic Status Assessment"
            },
            {
              "url": "statement",
              "valueString": "define \"Has No Record Of Glycemic Status Assessment\":   not exists \"Glycemic Status Assessment\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS122FHIRDiabetesAssessGreaterThan9Percent"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":   \"Has Most Recent Glycemic Status Assessment Without Result\"     or \"Has Most Recent Elevated Glycemic Status Assessment\"     or \"Has No Record Of Glycemic Status Assessment\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS122FHIRDiabetesAssessGreaterThan9Percent"
            },
            {
              "url": "name",
              "valueString": "Qualifying Encounters"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying Encounters\":   ( ( [Encounter: \"Office Visit\"]       union [Encounter: \"Annual Wellness Visit\"]       union [Encounter: \"Preventive Care Services Established Office Visit, 18 and Up\"]       union [Encounter: \"Preventive Care Services Initial Office Visit, 18 and Up\"]       union [Encounter: \"Home Healthcare Services\"]       union [Encounter: \"Nutrition Services\"]       union ( [Encounter] E           where exists ( ( E.type ) T               where T ~ \"Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes\"           )       )       union ( [Encounter] E           where exists ( ( E.type ) T               where T ~ \"Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes\"           )       )       union ( [Encounter] E           where exists ( ( E.type ) T               where T ~ \"Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes\"           )       )       union ( [Encounter] E           where exists ( ( E.type ) T               where T ~ \"Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes\"           )       )       union ( [Encounter] E           where exists ( ( E.type ) T               where T ~ \"Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes\"           )       )       union [Encounter: \"Telephone Visits\"]   ).isEncounterPerformed ( ) ) ValidEncounters     where ValidEncounters.period during day of \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS122FHIRDiabetesAssessGreaterThan9Percent"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":   AgeInYearsAt(date from      end of \"Measurement Period\"   ) in Interval[18, 75]     and exists \"Qualifying Encounters\"     and exists ( ( ( [ConditionEncounterDiagnosis: \"Diabetes\"] ).verified ( ) ) DiabetesDiagnosis         where DiabetesDiagnosis.prevalenceInterval ( ) overlaps day of \"Measurement Period\"     )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS122FHIRDiabetesAssessGreaterThan9Percent"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":   \"Initial Population\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":   [Coverage: type in \"Payer Type\"] Payer     return {       code: Payer.type,       period: Payer.period     }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS122FHIRDiabetesAssessGreaterThan9Percent"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":   SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":   Patient.ethnicity E     return Tuple {       codes: { E.ombCategory } union E.detailed,       display: E.text     }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS122FHIRDiabetesAssessGreaterThan9Percent"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":   SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Hospice"
            },
            {
              "url": "name",
              "valueString": "Has Hospice Services"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Hospice Services\":   exists ((([Encounter: \"Encounter Inpatient\"]).isEncounterPerformed()) InpatientEncounter       where (InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"           or InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"       )         and InpatientEncounter.period ends during day of \"Measurement Period\"   )     or exists ((([Encounter: \"Hospice Encounter\"]).isEncounterPerformed()) HospiceEncounter         where HospiceEncounter.period overlaps day of \"Measurement Period\"     )     or exists ((([ObservationScreeningAssessment: \"Hospice care [Minimum Data Set]\"]).isAssessmentPerformed()) HospiceAssessment         where HospiceAssessment.value ~ \"Yes (qualifier value)\"           and HospiceAssessment.effective.toInterval() overlaps day of \"Measurement Period\"     )     or exists ((([ServiceRequest: \"Hospice Care Ambulatory\"]).isInterventionOrder()) HospiceOrder         where HospiceOrder.authoredOn during day of \"Measurement Period\"     )     or exists ((([Procedure: \"Hospice Care Ambulatory\"]).isInterventionPerformed()) HospicePerformed         where HospicePerformed.performed.toInterval() overlaps day of \"Measurement Period\"     )     or exists ((([ConditionProblemsHealthConcerns: \"Hospice Diagnosis\"]         union [ConditionEncounterDiagnosis: \"Hospice Diagnosis\"]).verified()) HospiceCareDiagnosis         where HospiceCareDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"     )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdvancedIllnessandFrailty"
            },
            {
              "url": "name",
              "valueString": "Is Age 66 or Older Living Long Term in a Nursing Home"
            },
            {
              "url": "statement",
              "valueString": "define \"Is Age 66 or Older Living Long Term in a Nursing Home\":   AgeInYearsAt(date from       end of \"Measurement Period\"   )>= 66     and ( ( Last( (([ObservationScreeningAssessment: \"Housing status\"]).isAssessmentPerformed()) HousingStatus               where HousingStatus.effective.toInterval() ends on or before            day of end of \"Measurement Period\"           sort by            end of effective.toInterval() asc       )) LastHousingStatus         where LastHousingStatus.value ~ \"Lives in nursing home (finding)\"     ) is not null"
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdvancedIllnessandFrailty"
            },
            {
              "url": "name",
              "valueString": "Has Criteria Indicating Frailty"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Criteria Indicating Frailty\":   exists ( (([DeviceRequest: \"Frailty Device\"]).isDeviceOrderPersonalUseDevices()) FrailtyDeviceOrder       where FrailtyDeviceOrder.authoredOn.toInterval() during day of \"Measurement Period\"   )     or exists ( (([ObservationScreeningAssessment: \"Medical equipment used\"]).isAssessmentPerformed()) EquipmentUsed         where EquipmentUsed.value as Concept in \"Frailty Device\"          and EquipmentUsed.effective.toInterval() ends during day of \"Measurement Period\"     )     or exists ( (([ConditionProblemsHealthConcerns: \"Frailty Diagnosis\"]     union [ConditionEncounterDiagnosis: \"Frailty Diagnosis\"]).verified()) FrailtyDiagnosis         where FrailtyDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"     )     or exists ( (([Encounter: \"Frailty Encounter\"]).isEncounterPerformed()) FrailtyEncounter         where FrailtyEncounter.period overlaps day of \"Measurement Period\"     )     or exists ( (([SimpleObservation: \"Frailty Symptom\"]).isSymptom()) FrailtySymptom         where FrailtySymptom.effective.toInterval() overlaps day of \"Measurement Period\"     )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdvancedIllnessandFrailty"
            },
            {
              "url": "name",
              "valueString": "Has Advanced Illness in Year Before or During Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Advanced Illness in Year Before or During Measurement Period\": exists ((([ConditionProblemsHealthConcerns: \"Advanced Illness\"] union [ConditionEncounterDiagnosis: \"Advanced Illness\"]).verified()) AdvancedIllnessDiagnosis where AdvancedIllnessDiagnosis.prevalenceInterval() starts during day of Interval[start of \"Measurement Period\" - 1 year, end of \"Measurement Period\"])"
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdvancedIllnessandFrailty"
            },
            {
              "url": "name",
              "valueString": "Has Dementia Medications in Year Before or During Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Dementia Medications in Year Before or During Measurement Period\":   exists (( ([MedicationRequest: \"Dementia Medications\"]).isMedicationActive()) DementiaMedication       where DementiaMedication.medicationRequestPeriod() overlaps day of Interval[start of \"Measurement Period\" - 1 year,          end of \"Measurement Period\"]   )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdvancedIllnessandFrailty"
            },
            {
              "url": "name",
              "valueString": "Is Age 66 or Older with Advanced Illness and Frailty"
            },
            {
              "url": "statement",
              "valueString": "define \"Is Age 66 or Older with Advanced Illness and Frailty\":    AgeInYearsAt(date from end of \"Measurement Period\")>= 66     and \"Has Criteria Indicating Frailty\"     and ( \"Has Advanced Illness in Year Before or During Measurement Period\"         or \"Has Dementia Medications in Year Before or During Measurement Period\"     )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "PalliativeCare"
            },
            {
              "url": "name",
              "valueString": "Has Palliative Care in the Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Palliative Care in the Measurement Period\":   exists ((([ObservationScreeningAssessment: \"Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)\"]).isAssessmentPerformed()) PalliativeAssessment       where PalliativeAssessment.effective.toInterval() overlaps day of \"Measurement Period\"   )     or exists ((([ConditionProblemsHealthConcerns: \"Palliative Care Diagnosis\"]     union [ConditionEncounterDiagnosis: \"Palliative Care Diagnosis\"]).verified()) PalliativeDiagnosis         where PalliativeDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"     )     or exists ((([Encounter: \"Palliative Care Encounter\"]).isEncounterPerformed()) PalliativeEncounter         where PalliativeEncounter.period overlaps day of \"Measurement Period\"     )     or exists ((([Procedure: \"Palliative Care Intervention\"]).isInterventionPerformed()) PalliativeIntervention         where PalliativeIntervention.performed.toInterval() overlaps day of \"Measurement Period\"     )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 22
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS122FHIRDiabetesAssessGreaterThan9Percent"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusions\":   Hospice.\"Has Hospice Services\"     or AIFrailLTCF.\"Is Age 66 or Older Living Long Term in a Nursing Home\"     or AIFrailLTCF.\"Is Age 66 or Older with Advanced Illness and Frailty\"     or PalliativeCare.\"Has Palliative Care in the Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 23
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":   Patient.race R     return Tuple {       codes: R.ombCategory union R.detailed,       display: R.text     }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 24
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS122FHIRDiabetesAssessGreaterThan9Percent"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":   SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 25
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value uri): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 26
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Status"
            },
            {
              "url": "name",
              "valueString": "isLaboratoryTestPerformed"
            },
            {
              "url": "statement",
              "valueString": "//Laboratory Test, Performed define fluent function isLaboratoryTestPerformed(Obs List<LaboratoryResultObservation>):   Obs O     where O.status in { 'final', 'amended', 'corrected' }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 27
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "latest"
            },
            {
              "url": "statement",
              "valueString": "/* @description: Given an interval, returns the ending point if the interval has an ending boundary specified, otherwise, returns the starting point */ define fluent function latest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):   (choice.toInterval()) period     return       if (period.\"hasEnd\"()) then end of period       else start of period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 28
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "hasEnd"
            },
            {
              "url": "statement",
              "valueString": "/* @description: Given an interval, returns true if the interval has an ending boundary specified (i.e. the end of the interval is not null and not the maximum DateTime value) */ define fluent function hasEnd(period Interval<DateTime> ):   not (     end of period is null       or end of period = maximum DateTime   )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 29
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Status"
            },
            {
              "url": "name",
              "valueString": "isEncounterPerformed"
            },
            {
              "url": "statement",
              "valueString": "//Encounter, Performed //General usage unless required otherwise by measure intent (e.g., follow-up encounters) define fluent function isEncounterPerformed(Enc List<Encounter>):   Enc E     where E.status = 'finished'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 30
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToConcept"
            },
            {
              "url": "statement",
              "valueString": "/* @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept. */ define function ToConcept(concept FHIR.CodeableConcept):     if concept is null then         null     else         System.Concept {             codes: concept.coding C return ToCode(C),             display: concept.text.value         }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 31
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToCode"
            },
            {
              "url": "statement",
              "valueString": "/* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding):     if coding is null then         null     else         System.Code {           code: coding.code.value,           system: coding.system.value,           version: coding.version.value,           display: coding.display.value         }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 32
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToInterval"
            },
            {
              "url": "statement",
              "valueString": "/* @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period) value to a CQL DateTime Interval @comment: If the start value of the given period is unspecified, the starting boundary of the resulting interval will be open (meaning the start of the interval is unknown, as opposed to interpreted as the beginning of time). */ define function ToInterval(period FHIR.Period):     if period is null then         null     else         if period.\"start\" is null then             Interval(period.\"start\".value, period.\"end\".value]         else             Interval[period.\"start\".value, period.\"end\".value]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 33
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Status"
            },
            {
              "url": "name",
              "valueString": "verified"
            },
            {
              "url": "statement",
              "valueString": "//This library contains functions used to constrain FHIR resource elements for measures authored by NCQA, based on QICore 6.0.0 resources including IG and authoring patterns. The functions may appear similar to some QICoreCommon functions but differ in that they have constraints that are relevant for measures authored by NCQA.  //Condition //Returns conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential define fluent function verified(conditions List<Choice<ConditionProblemsHealthConcerns, ConditionEncounterDiagnosis>>):   conditions C     where C.verificationStatus is not null implies       (C.verificationStatus ~ \"confirmed\"         or C.verificationStatus ~ \"unconfirmed\"         or C.verificationStatus ~ \"provisional\"         or C.verificationStatus ~ \"differential\"       )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 34
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Status"
            },
            {
              "url": "name",
              "valueString": "isAssessmentPerformed"
            },
            {
              "url": "statement",
              "valueString": "//Assessment, Performed define fluent function isAssessmentPerformed(Obs List<ObservationScreeningAssessment>):   Obs O     where O.status in { 'final', 'amended', 'corrected' }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 35
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Status"
            },
            {
              "url": "name",
              "valueString": "isInterventionOrder"
            },
            {
              "url": "statement",
              "valueString": "//Intervention, Order define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):   ServiceRequest S     where S.status in { 'active', 'completed' }       and S.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}"
            },
            {
              "url": "displaySequence",
              "valueInteger": 36
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Status"
            },
            {
              "url": "name",
              "valueString": "isInterventionPerformed"
            },
            {
              "url": "statement",
              "valueString": "//Intervention, Performed define fluent function isInterventionPerformed(Proc List<Procedure>):   Proc P     where P.status ~ 'completed'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 37
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "toInterval"
            },
            {
              "url": "statement",
              "valueString": "/* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in QICore, allowing this function to be used across any resource. The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime. If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age, and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later. If the input is a DateTime Interval, the result is the input. If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending immediately before one year later than the date the patient turned the age given as the end of the quantity interval. If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval */ define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):   case    when choice is DateTime then      Interval[choice as DateTime, choice as DateTime]   when choice is Interval<DateTime> then     choice as Interval<DateTime>   when choice is Quantity then     Interval[Patient.birthDate + (choice as Quantity),      Patient.birthDate + (choice as Quantity) + 1 year)   when choice is Interval<Quantity> then     Interval[Patient.birthDate + (choice.low as Quantity),      Patient.birthDate + (choice.high as Quantity) + 1 year)   when choice is Timing then       Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>   else    null as Interval<DateTime>  end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 38
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Status"
            },
            {
              "url": "name",
              "valueString": "isDeviceOrderPersonalUseDevices"
            },
            {
              "url": "statement",
              "valueString": "//Device, Order - Personal Use Devices define fluent function isDeviceOrderPersonalUseDevices(DeviceRequest List<DeviceRequest>):   DeviceRequest D     where D.status in { 'active', 'completed' }       and D.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}"
            },
            {
              "url": "displaySequence",
              "valueInteger": 39
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Status"
            },
            {
              "url": "name",
              "valueString": "isSymptom"
            },
            {
              "url": "statement",
              "valueString": "//Symptom define fluent function isSymptom(Obs List<SimpleObservation>):   Obs O     where O.status in { 'preliminary', 'final', 'amended', 'corrected' }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 40
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Status"
            },
            {
              "url": "name",
              "valueString": "isMedicationActive"
            },
            {
              "url": "statement",
              "valueString": "//Medication, Active define fluent function isMedicationActive(MedicationRequest List<MedicationRequest>):   MedicationRequest M     where M.status = 'active'       and M.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}"
            },
            {
              "url": "displaySequence",
              "valueInteger": 41
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CumulativeMedicationDuration"
            },
            {
              "url": "name",
              "valueString": "medicationRequestPeriod"
            },
            {
              "url": "statement",
              "valueString": "define fluent function medicationRequestPeriod(Request \"MedicationRequest\"):   Request R     let       dosage: singleton from R.dosageInstruction,       doseAndRate: singleton from dosage.doseAndRate,       timing: dosage.timing,       frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),       period: Quantity(timing.repeat.period, timing.repeat.periodUnit),       doseRange: doseAndRate.dose,       doseQuantity: doseAndRate.dose,       dose: Coalesce(end of doseRange, doseQuantity),       dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),       boundsPeriod: timing.repeat.bounds as Interval<DateTime>,       daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value,       quantity: R.dispenseRequest.quantity,       refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),       startDate:         Coalesce(           date from start of boundsPeriod,           date from R.authoredOn,           date from start of R.dispenseRequest.validityPeriod         ),       totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)     return       if startDate is not null and totalDaysSupplied is not null then         Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]       else if startDate is not null and boundsPeriod.\"high\" is not null then         Interval[startDate, date from end of boundsPeriod]       else         null"
            },
            {
              "url": "displaySequence",
              "valueInteger": 42
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CumulativeMedicationDuration"
            },
            {
              "url": "name",
              "valueString": "Quantity"
            },
            {
              "url": "statement",
              "valueString": "/**********************************************************************/ /* Functions in this region are copied from opioid-mme-r4             */ /**********************************************************************/  define function Quantity(value Decimal, unit String):   if value is not null then     System.Quantity { value: value, unit: unit }   else     null"
            },
            {
              "url": "displaySequence",
              "valueInteger": 43
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CumulativeMedicationDuration"
            },
            {
              "url": "name",
              "valueString": "ToDaily"
            },
            {
              "url": "statement",
              "valueString": "/*  Goal is to get to number of days  Two broad approaches to the calculation:   1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered   2) Based on relevant period, determine a covered interval and calculate the length of that interval in days This topic covers several use cases and illustrates how to calculate Cumulative Medication Duration for each type of medication resource using the supply and frequency approach. */  /*   For the first approach, we need to get from frequency to a frequency/day   So we define ToDaily */  /*   Calculates daily frequency given frequency within a period */ define function ToDaily(frequency System.Integer, period System.Quantity):   case period.unit     when 'h' then frequency * (24.0 / period.value)     when 'min' then frequency * (24.0 / period.value) * 60     when 's' then frequency * (24.0 / period.value) * 60 * 60     when 'd' then frequency * (24.0 / period.value) / 24     when 'wk' then frequency * (24.0 / period.value) / (24 * 7)     when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */     when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */     when 'hour' then frequency * (24.0 / period.value)     when 'minute' then frequency * (24.0 / period.value) * 60     when 'second' then frequency * (24.0 / period.value) * 60 * 60     when 'day' then frequency * (24.0 / period.value) / 24     when 'week' then frequency * (24.0 / period.value) / (24 * 7)     when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */     when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */     when 'hours' then frequency * (24.0 / period.value)     when 'minutes' then frequency * (24.0 / period.value) * 60     when 'seconds' then frequency * (24.0 / period.value) * 60 * 60     when 'days' then frequency * (24.0 / period.value) / 24     when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)     when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */     when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */     else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit)   end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 44
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        }
      ],
      "name": "EffectiveDataRequirements",
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/library-type",
            "code": "module-definition"
          }
        ]
      },
      "relatedArtifact": [
        {
          "type": "depends-on",
          "display": "Library SDE",
          "resource": "https://madie.cms.gov/Library/SupplementalDataElements|5.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "https://madie.cms.gov/Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library Status",
          "resource": "https://madie.cms.gov/Library/Status|1.15.000"
        },
        {
          "type": "depends-on",
          "display": "Library QICoreCommon",
          "resource": "https://madie.cms.gov/Library/QICoreCommon|4.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library Hospice",
          "resource": "https://madie.cms.gov/Library/Hospice|6.18.000"
        },
        {
          "type": "depends-on",
          "display": "Library AIFrailLTCF",
          "resource": "https://madie.cms.gov/Library/AdvancedIllnessandFrailty|1.27.000"
        },
        {
          "type": "depends-on",
          "display": "Library CMD",
          "resource": "https://madie.cms.gov/Library/CumulativeMedicationDuration|6.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library PalliativeCare",
          "resource": "https://madie.cms.gov/Library/PalliativeCare|1.18.000"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Code system LOINC",
          "resource": "http://loinc.org"
        },
        {
          "type": "depends-on",
          "display": "Code system CPT",
          "resource": "http://www.ama-assn.org/go/cpt"
        },
        {
          "type": "depends-on",
          "display": "Code system HCPCS",
          "resource": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"
        },
        {
          "type": "depends-on",
          "display": "Code system ConditionVerificationStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/condition-ver-status"
        },
        {
          "type": "depends-on",
          "display": "Value set HbA1c Laboratory Test",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1013"
        },
        {
          "type": "depends-on",
          "display": "Value set Office Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
        },
        {
          "type": "depends-on",
          "display": "Value set Annual Wellness Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"
        },
        {
          "type": "depends-on",
          "display": "Value set Preventive Care Services Established Office Visit, 18 and Up",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"
        },
        {
          "type": "depends-on",
          "display": "Value set Preventive Care Services Initial Office Visit, 18 and Up",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"
        },
        {
          "type": "depends-on",
          "display": "Value set Home Healthcare Services",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"
        },
        {
          "type": "depends-on",
          "display": "Value set Nutrition Services",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1006"
        },
        {
          "type": "depends-on",
          "display": "Value set Telephone Visits",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"
        },
        {
          "type": "depends-on",
          "display": "Value set Diabetes",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.103.12.1001"
        },
        {
          "type": "depends-on",
          "display": "Value set Payer Type",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
        },
        {
          "type": "depends-on",
          "display": "Value set Encounter Inpatient",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
        },
        {
          "type": "depends-on",
          "display": "Value set Hospice Encounter",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"
        },
        {
          "type": "depends-on",
          "display": "Value set Hospice Care Ambulatory",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"
        },
        {
          "type": "depends-on",
          "display": "Value set Hospice Diagnosis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165"
        },
        {
          "type": "depends-on",
          "display": "Value set Frailty Device",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300"
        },
        {
          "type": "depends-on",
          "display": "Value set Frailty Diagnosis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1074"
        },
        {
          "type": "depends-on",
          "display": "Value set Frailty Encounter",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1088"
        },
        {
          "type": "depends-on",
          "display": "Value set Frailty Symptom",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1075"
        },
        {
          "type": "depends-on",
          "display": "Value set Advanced Illness",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1082"
        },
        {
          "type": "depends-on",
          "display": "Value set Dementia Medications",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510"
        },
        {
          "type": "depends-on",
          "display": "Value set Palliative Care Diagnosis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167"
        },
        {
          "type": "depends-on",
          "display": "Value set Palliative Care Encounter",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090"
        },
        {
          "type": "depends-on",
          "display": "Value set Palliative Care Intervention",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135"
        }
      ],
      "parameter": [
        {
          "name": "Measurement Period",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "Period"
        },
        {
          "name": "ErrorLevel",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "string"
        },
        {
          "name": "Numerator",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "Denominator",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "Initial Population",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "Denominator Exclusions",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "SDE Sex",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Coding"
        },
        {
          "name": "SDE Payer",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Ethnicity",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        },
        {
          "name": "SDE Race",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        }
      ],
      "dataRequirement": [
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "extension",
            "url",
            "birthDate",
            "birthDate.value"
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "effective",
            "value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1013"
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "effective",
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        {
          "url": "guidance",
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      "valueReference": {
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      "use": "usual",
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        ]
      },
      "system": "https://madie.cms.gov/measure/shortName",
      "value": "CMS122FHIR"
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    {
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    {
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      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:c3fece64-fdcf-438c-ba72-3a34eef3c81f"
    },
    {
      "use": "official",
      "type": {
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            "code": "publisher",
            "display": "Publisher"
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      "system": "https://madie.cms.gov/measure/cmsId",
      "value": "122FHIR",
      "assigner": {
        "display": "CMS"
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  "version": "0.5.000",
  "name": "CMS122FHIRDiabetesAssessGreaterThan9Percent",
  "title": "Diabetes: Glycemic Status Assessment Greater Than 9%FHIR",
  "status": "active",
  "experimental": false,
  "date": "2025-06-27T17:22:54+00:00",
  "publisher": "National Committee for Quality Assurance",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "https://www.ncqa.org/"
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  ],
  "description": "Percentage of patients 18-75 years of age with diabetes who had a glycemic status assessment (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) > 9.0% during the measurement period",
  "usage": "If the glycemic status assessment (HbA1c or GMI) is in the medical record, the test can be used to determine numerator compliance.  Glycemic status assessment (HbA1c or GMI) must be reported as a percentage (%).  If multiple glycemic status assessments were recorded for a single date, use the lowest result.  This eCQM is a patient-based measure.  This FHIR-based measure has been derived from the QDM-based measure: CMS122v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6. (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).",
  "copyright": "This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties or endorsements about the quality of any product, test or protocol identified as numerator compliant or otherwise identified as meeting the requirements of the measure or specification. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure may be used for internal, noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. All other uses, including a commercial use (including but not limited to vendors using or embedding the measures and specifications into any product or service to calculate measure results for customers for any purpose), must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2025 National Committee for Quality Assurance. All Rights Reserved.  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. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications.  CPT(R) codes, descriptions and other data are copyright 2025. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use.  Some measure specifications contain coding from LOINC(R) (https://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2025 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at https://loinc.org/kb/license/.  This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation.   ICD-10 copyright 2025 World Health Organization. All Rights Reserved.  Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product.  “HL7” is the registered trademark of Health Level Seven International.",
  "effectivePeriod": {
    "start": "2026-01-01",
    "end": "2026-12-31"
  },
  "author": [
    {
      "name": "National Committee for Quality Assurance",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.ncqa.org/"
        }
      ]
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "citation": "Citation - American Diabetes Association. (2018). Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care, 41, 917-928. Retrieved from http://care.diabetesjournals.org/content/early/2018/03/20/dci18-0007 "
    },
    {
      "type": "citation",
      "citation": "Citation - American Diabetes Association. (2022a). Statistics About Diabetes. Retrieved from https://diabetes.org/about-us/statistics/about-diabetes "
    },
    {
      "type": "citation",
      "citation": "Citation - Centers for Disease Control and Prevention. (2022a). What is Diabetes? Retrieved from https://www.cdc.gov/diabetes/basics/diabetes.html "
    },
    {
      "type": "citation",
      "citation": "Citation - Centers for Disease Control and Prevention. (2022b). Diabetes Report Card 2021. US Dept of Health and Human Services. Retrieved from https://archive.cdc.gov/www_cdc_gov/diabetes/library/reports/reportcard.html "
    },
    {
      "type": "citation",
      "citation": "Citation - ElSayed, N.A., Aleppo, G., Ardoda, V.R., Bannuru, R.B., Brown, F.M., Bruemmer, D.,…Staton, R.C., American Diabetes Association (ADA). (2022). 6. Glycemic Targets: Standards of Care in Diabetes—2023. Diabetes Care 2023,46(Supplement_1):S97–S110. https://doi.org/10.2337/dc23-S006 "
    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS122FHIRDiabetesAssessGreaterThan9Percent"
  ],
  "disclaimer": "The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.   Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
  "rationale": "Diabetes is the seventh leading cause of death in the United States (Centers for Disease Control and Prevention [CDC], 2022a). In 2019, diabetes affected more than 37 million Americans (11.3% of the U.S. population) and killed more than 87,000 people (American Diabetes Association [ADA], 2022a). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC, 2022a). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney damage, amputation of feet or legs, and premature death (CDC, 2022b).   In 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34% increase from the estimated $245 billion spent on diabetes in 2012 (ADA, 2018).  Controlling A1c blood levels helps reduce the risk of microvascular complications (eye, kidney and nerve diseases) (ADA, 2022b).",
  "clinicalRecommendationStatement": "American Diabetes Association (2023):  - Assess glycemic status (A1C or other glycemic measurement such as time in range or glucose management indicator) at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). (Level of evidence: E)  - An A1C goal for many nonpregnant adults of <7% (53 mmol/mol) without significant hypoglycemia is appropriate. (Level of evidence: A)  - On the basis of health care professional judgement and patient preference, achievement of lower A1C levels than the goal of 7% may be acceptable and even beneficial if it can be achieved safely without significant hypoglycemia or other adverse effects of treatment. (Level of evidence: B)  - Less stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with limited life expectancy or where the harms of treatment are greater than the benefits. Health care professionals should consider deintensification of therapy if appropriate to reduce the risk of hypoglycemia in patients with inappropriate stringent A1C targets. (Level of evidence: B)  - Standardized, single-page glucose reports from continuous glucose monitoring (CGM) devices with visual cues, such as the ambulatory glucose profile, should be considered as a standard summary for all CGM devices. Level of evidence: E",
  "group": [
    {
      "id": "Group_1",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                "code": "proportion",
                "display": "Proportion"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
          "valueCode": "boolean"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-type",
                "code": "outcome",
                "display": "Outcome"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "None"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        }
      ],
      "population": [
        {
          "id": "InitialPopulation_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Patients 18-75 years of age by the end of the measurement period, with diabetes with a visit during the measurement period",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "Denominator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator",
                "display": "Denominator"
              }
            ]
          },
          "description": "Equals Initial Population",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator"
          }
        },
        {
          "id": "DenominatorExclusion_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exclusion",
                "display": "Denominator Exclusion"
              }
            ]
          },
          "description": "Exclude patients who are in hospice care for any part of the measurement period.  Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period.  Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior   Exclude patients receiving palliative care for any part of the measurement period.",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exclusions"
          }
        },
        {
          "id": "Numerator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Patients whose most recent glycemic status assessment (HbA1c or GMI) (performed during the measurement period) is >9.0% or is missing, or was not performed during the measurement period",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        }
      ]
    }
  ],
  "supplementalData": [
    {
      "id": "sde-ethnicity",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Ethnicity",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Ethnicity"
      }
    },
    {
      "id": "sde-payer",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Payer",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Payer"
      }
    },
    {
      "id": "sde-race",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Race",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Race"
      }
    },
    {
      "id": "sde-sex",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Sex",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Sex"
      }
    }
  ]
}