FHIR IG Statistics: Measure/CMS2FHIRPCSDepressionScreenAndFollowUp

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define "Initial Population":   "Patient Age 12 Years or Older at Start of Measurement Period"     and exists ( "Qualifying Encounter During Measurement Period" )

define "Denominator":   "Initial Population"

define "Denominator Exclusions":   exists "History of Bipolar Diagnosis Before Qualifying Encounter"

define "Numerator":   ( "Patient Age 12 to 16 Years at Start of Measurement Period"       and ( "Has Most Recent Adolescent Screening Negative"           or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided"       )   )     or ( "Patient Age 17 Years at Start of Measurement Period"         and ( "Has Most Recent Adolescent Screening Negative"             or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided"             or "Has Most Recent Adult Screening Negative"             or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided"         )     )     or ( "Patient Age 18 Years or Older at Start of Measurement Period"         and ( "Has Most Recent Adult Screening Negative"             or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided"         )     )

define "Denominator Exceptions":   ( exists "Medical or Patient Reason for Not Screening Adolescent for Depression"       and not "Has Adolescent Depression Screening"   )     or ( exists "Medical or Patient Reason for Not Screening Adult for Depression"         and not "Has Adult Depression Screening"     )

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 "Patient Age 12 to 16 Years at Start of Measurement Period":   AgeInYearsAt(date from start of "Measurement Period") in Interval[12, 16]

define "Qualifying Encounter During Measurement Period":   ( [Encounter: type in "Encounter to Screen for Depression"]     union [Encounter: "Physical Therapy Evaluation"]     union [Encounter: "Telephone Visits"] ) QualifyingEncounter     where QualifyingEncounter.period during day of "Measurement Period"       and QualifyingEncounter.status = 'finished'

define "Most Recent Adolescent Depression Screening":   Last([ObservationScreeningAssessment: "Adolescent depression screening assessment"] AdolescentDepressionScreening       with "Qualifying Encounter During Measurement Period" QualifyingEncounter         such that AdolescentDepressionScreening.effective.toInterval() 14 days or less on or before day of start of QualifyingEncounter.period           and AdolescentDepressionScreening.value is not null           and AdolescentDepressionScreening.status in { 'final', 'corrected' }       sort by start of effective.toInterval()   )

define "Has Most Recent Adolescent Screening Negative":   ( "Most Recent Adolescent Depression Screening" AdolescentScreen       where AdolescentScreen.value ~ "Depression screening negative (finding)"   ) is not null

define "Follow Up Intervention for Positive Adolescent Depression Screening":   ( ( [MedicationRequest: "Adolescent Depression Medications"] AdolescentMed         with "Qualifying Encounter During Measurement Period" QualifyingEncounter           such that "Most Recent Adolescent Depression Screening".effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period             and AdolescentMed.medicationRequestPeriod ( ).toInterval ( ) overlaps after day of QualifyingEncounter.period             and "Most Recent Adolescent Depression Screening".value ~ "Depression screening positive (finding)"             and AdolescentMed.status in { 'active', 'completed' }             and AdolescentMed.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }     )       union ( [ServiceRequest: "Referral for Adolescent Depression"] AdolescentReferral           where AdolescentReferral.status in { 'active', 'completed' }       )       union ( [Procedure: "Follow Up for Adolescent Depression"] AdolescentFollowUp           where AdolescentFollowUp.status = 'completed'       )   )

define "Most Recent Adolescent Depression Screening Positive and Follow Up Provided":   from     "Most Recent Adolescent Depression Screening" LastAdolescentScreen,     "Follow Up Intervention for Positive Adolescent Depression Screening" FollowUpPositiveAdolescentScreen,     "Qualifying Encounter During Measurement Period" QualifyingEncounter     where LastAdolescentScreen.effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period       and LastAdolescentScreen.value ~ "Depression screening positive (finding)"       and ( start of FollowUpPositiveAdolescentScreen.performed.toInterval ( ) during QualifyingEncounter.period           or FollowUpPositiveAdolescentScreen.authoredOn 2 days or less on or after day of end of QualifyingEncounter.period       )       and ( Coalesce(start of FollowUpPositiveAdolescentScreen.performed.toInterval(), FollowUpPositiveAdolescentScreen.authoredOn) during day of "Measurement Period" )

define "Patient Age 17 Years at Start of Measurement Period":   AgeInYearsAt(date from start of "Measurement Period") = 17

define "Most Recent Adult Depression Screening":   Last([ObservationScreeningAssessment: "Adult depression screening assessment"] AdultDepressionScreening       with "Qualifying Encounter During Measurement Period" QualifyingEncounter         such that AdultDepressionScreening.effective.toInterval() 14 days or less on or before day of start of QualifyingEncounter.period           and AdultDepressionScreening.value is not null           and AdultDepressionScreening.status in { 'final', 'corrected' }       sort by start of effective.toInterval()   )

define "Has Most Recent Adult Screening Negative":   ( "Most Recent Adult Depression Screening" AdultScreen       where AdultScreen.value ~ "Depression screening negative (finding)"   ) is not null

define "Follow Up Intervention for Positive Adult Depression Screening":   ( ( [MedicationRequest: "Adult Depression Medications"] AdultMed         with "Qualifying Encounter During Measurement Period" QualifyingEncounter           such that "Most Recent Adult Depression Screening".effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period             and AdultMed.medicationRequestPeriod ( ).toInterval ( ) overlaps after day of QualifyingEncounter.period             and "Most Recent Adult Depression Screening".value ~ "Depression screening positive (finding)"             and AdultMed.status in { 'active', 'completed' }             and AdultMed.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }     )       union ( [ServiceRequest: "Referral for Adult Depression"] AdultReferral           where AdultReferral.status in { 'active', 'completed' }       )       union ( [Procedure: "Follow Up for Adult Depression"] AdultFollowUp           where AdultFollowUp.status = 'completed'       )   )

define "Most Recent Adult Depression Screening Positive and Follow Up Provided":   from     "Most Recent Adult Depression Screening" LastAdultScreen,     "Follow Up Intervention for Positive Adult Depression Screening" FollowUpPositiveAdultScreen,     "Qualifying Encounter During Measurement Period" QualifyingEncounter     where LastAdultScreen.effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period       and LastAdultScreen.value ~ "Depression screening positive (finding)"       and ( start of FollowUpPositiveAdultScreen.performed.toInterval ( ) during QualifyingEncounter.period           or FollowUpPositiveAdultScreen.authoredOn 2 days or less on or after day of end of QualifyingEncounter.period       )       and ( Coalesce(start of FollowUpPositiveAdultScreen.performed.toInterval(), FollowUpPositiveAdultScreen.authoredOn) during day of "Measurement Period" )

define "Patient Age 18 Years or Older at Start of Measurement Period":   AgeInYearsAt(date from start of "Measurement Period") >= 18

define "Numerator":   ( "Patient Age 12 to 16 Years at Start of Measurement Period"       and ( "Has Most Recent Adolescent Screening Negative"           or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided"       )   )     or ( "Patient Age 17 Years at Start of Measurement Period"         and ( "Has Most Recent Adolescent Screening Negative"             or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided"             or "Has Most Recent Adult Screening Negative"             or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided"         )     )     or ( "Patient Age 18 Years or Older at Start of Measurement Period"         and ( "Has Most Recent Adult Screening Negative"             or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided"         )     )

define "Patient Age 12 Years or Older at Start of Measurement Period":   AgeInYearsAt(date from start of "Measurement Period") >= 12

define "Initial Population":   "Patient Age 12 Years or Older at Start of Measurement Period"     and exists ( "Qualifying Encounter During Measurement Period" )

define "Denominator":   "Initial Population"

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

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

define "History of Bipolar Diagnosis Before Qualifying Encounter":   [ConditionProblemsHealthConcerns: "Bipolar Disorder"] BipolarDiagnosis     with "Qualifying Encounter During Measurement Period" QualifyingEncounter       such that BipolarDiagnosis.prevalenceInterval ( ) starts before day of start of QualifyingEncounter.period

define "Denominator Exclusions":   exists "History of Bipolar Diagnosis Before Qualifying Encounter"

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

define "Medical or Patient Reason for Not Screening Adolescent for Depression":   [ObservationCancelled: code ~ "Adolescent depression screening assessment"] NoAdolescentScreen     with "Qualifying Encounter During Measurement Period" QualifyingEncounter       such that NoAdolescentScreen.issued during day of QualifyingEncounter.period     where ( NoAdolescentScreen.notDoneReason ~ "Depression screening declined (situation)"         or NoAdolescentScreen.notDoneReason in "Medical Reason"     )

define "Has Adolescent Depression Screening":   exists ( [ObservationScreeningAssessment: "Adolescent depression screening assessment"] AdolescentScreening       with "Qualifying Encounter During Measurement Period" QualifyingEncounter         such that AdolescentScreening.effective.toInterval ( ) 14 days or less on or before day of start of QualifyingEncounter.period           and AdolescentScreening.value is not null           and AdolescentScreening.status in { 'final', 'corrected' }   )

define "Medical or Patient Reason for Not Screening Adult for Depression":   [ObservationCancelled: code ~ "Adult depression screening assessment"] NoAdultScreen     with "Qualifying Encounter During Measurement Period" QualifyingEncounter       such that NoAdultScreen.issued during day of QualifyingEncounter.period     where ( NoAdultScreen.notDoneReason ~ "Depression screening declined (situation)"         or NoAdultScreen.notDoneReason in "Medical Reason"     )

define "Has Adult Depression Screening":   exists ( [ObservationScreeningAssessment: "Adult depression screening assessment"] AdultScreening       with "Qualifying Encounter During Measurement Period" QualifyingEncounter         such that AdultScreening.effective.toInterval ( ) 14 days or less on or before day of start of QualifyingEncounter.period           and AdultScreening.value is not null           and AdultScreening.status in { 'final', 'corrected' }   )

define "Denominator Exceptions":   ( exists "Medical or Patient Reason for Not Screening Adolescent for Depression"       and not "Has Adolescent Depression Screening"   )     or ( exists "Medical or Patient Reason for Not Screening Adult for Depression"         and not "Has Adult Depression Screening"     )

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

define function ToString(value uri): value.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: 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: 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

/* @description: Returns an interval representing the normalized prevalence period of a given Condition. @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting  interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary. */ define fluent function prevalenceInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">): if condition.clinicalStatus ~ "active"   or condition.clinicalStatus ~ "recurrence"   or condition.clinicalStatus ~ "relapse" then   Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()] else     (end of condition.abatementInterval()) abatementDate     return if abatementDate is null then       Interval[start of condition.onset.toInterval(), abatementDate)     else       Interval[start of condition.onset.toInterval(), abatementDate]

/* @description: Returns an interval representing the normalized abatement of a given Condition. @comment: If the abatement element of the Condition is represented as a DateTime, the result is an interval beginning and ending on that DateTime. If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The result is an interval from the date the patient turned that age to immediately before one year later. If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately before one year later than the date the patient turned the ending age of the quantity interval. */ define fluent function abatementInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):  if condition.abatement is DateTime then    Interval[condition.abatement as DateTime, condition.abatement as DateTime]  else if condition.abatement is Quantity then   Interval[Patient.birthDate + (condition.abatement as Quantity),    Patient.birthDate + (condition.abatement as Quantity) + 1 year)  else if condition.abatement is Interval<Quantity> then    Interval[Patient.birthDate + (condition.abatement.low as Quantity),     Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)  else if condition.abatement is Interval<DateTime> then    Interval[condition.abatement.low, condition.abatement.high)  else null as Interval<DateTime>

Source

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  "id": "CMS2FHIRPCSDepressionScreenAndFollowUp",
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            {
              "url": "name",
              "valueString": "Has Most Recent Adolescent Screening Negative"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Most Recent Adolescent Screening Negative\":   ( \"Most Recent Adolescent Depression Screening\" AdolescentScreen       where AdolescentScreen.value ~ \"Depression screening negative (finding)\"   ) is not null"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Follow Up Intervention for Positive Adolescent Depression Screening"
            },
            {
              "url": "statement",
              "valueString": "define \"Follow Up Intervention for Positive Adolescent Depression Screening\":   ( ( [MedicationRequest: \"Adolescent Depression Medications\"] AdolescentMed         with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter           such that \"Most Recent Adolescent Depression Screening\".effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period             and AdolescentMed.medicationRequestPeriod ( ).toInterval ( ) overlaps after day of QualifyingEncounter.period             and \"Most Recent Adolescent Depression Screening\".value ~ \"Depression screening positive (finding)\"             and AdolescentMed.status in { 'active', 'completed' }             and AdolescentMed.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }     )       union ( [ServiceRequest: \"Referral for Adolescent Depression\"] AdolescentReferral           where AdolescentReferral.status in { 'active', 'completed' }       )       union ( [Procedure: \"Follow Up for Adolescent Depression\"] AdolescentFollowUp           where AdolescentFollowUp.status = 'completed'       )   )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Most Recent Adolescent Depression Screening Positive and Follow Up Provided"
            },
            {
              "url": "statement",
              "valueString": "define \"Most Recent Adolescent Depression Screening Positive and Follow Up Provided\":   from     \"Most Recent Adolescent Depression Screening\" LastAdolescentScreen,     \"Follow Up Intervention for Positive Adolescent Depression Screening\" FollowUpPositiveAdolescentScreen,     \"Qualifying Encounter During Measurement Period\" QualifyingEncounter     where LastAdolescentScreen.effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period       and LastAdolescentScreen.value ~ \"Depression screening positive (finding)\"       and ( start of FollowUpPositiveAdolescentScreen.performed.toInterval ( ) during QualifyingEncounter.period           or FollowUpPositiveAdolescentScreen.authoredOn 2 days or less on or after day of end of QualifyingEncounter.period       )       and ( Coalesce(start of FollowUpPositiveAdolescentScreen.performed.toInterval(), FollowUpPositiveAdolescentScreen.authoredOn) during day of \"Measurement Period\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Patient Age 17 Years at Start of Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Patient Age 17 Years at Start of Measurement Period\":   AgeInYearsAt(date from start of \"Measurement Period\") = 17"
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Most Recent Adult Depression Screening"
            },
            {
              "url": "statement",
              "valueString": "define \"Most Recent Adult Depression Screening\":   Last([ObservationScreeningAssessment: \"Adult depression screening assessment\"] AdultDepressionScreening       with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter         such that AdultDepressionScreening.effective.toInterval() 14 days or less on or before day of start of QualifyingEncounter.period           and AdultDepressionScreening.value is not null           and AdultDepressionScreening.status in { 'final', 'corrected' }       sort by start of effective.toInterval()   )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Has Most Recent Adult Screening Negative"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Most Recent Adult Screening Negative\":   ( \"Most Recent Adult Depression Screening\" AdultScreen       where AdultScreen.value ~ \"Depression screening negative (finding)\"   ) is not null"
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Follow Up Intervention for Positive Adult Depression Screening"
            },
            {
              "url": "statement",
              "valueString": "define \"Follow Up Intervention for Positive Adult Depression Screening\":   ( ( [MedicationRequest: \"Adult Depression Medications\"] AdultMed         with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter           such that \"Most Recent Adult Depression Screening\".effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period             and AdultMed.medicationRequestPeriod ( ).toInterval ( ) overlaps after day of QualifyingEncounter.period             and \"Most Recent Adult Depression Screening\".value ~ \"Depression screening positive (finding)\"             and AdultMed.status in { 'active', 'completed' }             and AdultMed.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }     )       union ( [ServiceRequest: \"Referral for Adult Depression\"] AdultReferral           where AdultReferral.status in { 'active', 'completed' }       )       union ( [Procedure: \"Follow Up for Adult Depression\"] AdultFollowUp           where AdultFollowUp.status = 'completed'       )   )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Most Recent Adult Depression Screening Positive and Follow Up Provided"
            },
            {
              "url": "statement",
              "valueString": "define \"Most Recent Adult Depression Screening Positive and Follow Up Provided\":   from     \"Most Recent Adult Depression Screening\" LastAdultScreen,     \"Follow Up Intervention for Positive Adult Depression Screening\" FollowUpPositiveAdultScreen,     \"Qualifying Encounter During Measurement Period\" QualifyingEncounter     where LastAdultScreen.effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period       and LastAdultScreen.value ~ \"Depression screening positive (finding)\"       and ( start of FollowUpPositiveAdultScreen.performed.toInterval ( ) during QualifyingEncounter.period           or FollowUpPositiveAdultScreen.authoredOn 2 days or less on or after day of end of QualifyingEncounter.period       )       and ( Coalesce(start of FollowUpPositiveAdultScreen.performed.toInterval(), FollowUpPositiveAdultScreen.authoredOn) during day of \"Measurement Period\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Patient Age 18 Years or Older at Start of Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Patient Age 18 Years or Older at Start of Measurement Period\":   AgeInYearsAt(date from start of \"Measurement Period\") >= 18"
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":   ( \"Patient Age 12 to 16 Years at Start of Measurement Period\"       and ( \"Has Most Recent Adolescent Screening Negative\"           or exists \"Most Recent Adolescent Depression Screening Positive and Follow Up Provided\"       )   )     or ( \"Patient Age 17 Years at Start of Measurement Period\"         and ( \"Has Most Recent Adolescent Screening Negative\"             or exists \"Most Recent Adolescent Depression Screening Positive and Follow Up Provided\"             or \"Has Most Recent Adult Screening Negative\"             or exists \"Most Recent Adult Depression Screening Positive and Follow Up Provided\"         )     )     or ( \"Patient Age 18 Years or Older at Start of Measurement Period\"         and ( \"Has Most Recent Adult Screening Negative\"             or exists \"Most Recent Adult Depression Screening Positive and Follow Up Provided\"         )     )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Patient Age 12 Years or Older at Start of Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Patient Age 12 Years or Older at Start of Measurement Period\":   AgeInYearsAt(date from start of \"Measurement Period\") >= 12"
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":   \"Patient Age 12 Years or Older at Start of Measurement Period\"     and exists ( \"Qualifying Encounter During Measurement Period\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":   \"Initial Population\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "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": 18
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":   SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "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": 20
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":   SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "History of Bipolar Diagnosis Before Qualifying Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"History of Bipolar Diagnosis Before Qualifying Encounter\":   [ConditionProblemsHealthConcerns: \"Bipolar Disorder\"] BipolarDiagnosis     with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter       such that BipolarDiagnosis.prevalenceInterval ( ) starts before day of start of QualifyingEncounter.period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 22
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusions\":   exists \"History of Bipolar Diagnosis Before Qualifying Encounter\""
            },
            {
              "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": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "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": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Medical or Patient Reason for Not Screening Adolescent for Depression"
            },
            {
              "url": "statement",
              "valueString": "define \"Medical or Patient Reason for Not Screening Adolescent for Depression\":   [ObservationCancelled: code ~ \"Adolescent depression screening assessment\"] NoAdolescentScreen     with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter       such that NoAdolescentScreen.issued during day of QualifyingEncounter.period     where ( NoAdolescentScreen.notDoneReason ~ \"Depression screening declined (situation)\"         or NoAdolescentScreen.notDoneReason in \"Medical Reason\"     )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 26
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Has Adolescent Depression Screening"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Adolescent Depression Screening\":   exists ( [ObservationScreeningAssessment: \"Adolescent depression screening assessment\"] AdolescentScreening       with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter         such that AdolescentScreening.effective.toInterval ( ) 14 days or less on or before day of start of QualifyingEncounter.period           and AdolescentScreening.value is not null           and AdolescentScreening.status in { 'final', 'corrected' }   )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 27
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Medical or Patient Reason for Not Screening Adult for Depression"
            },
            {
              "url": "statement",
              "valueString": "define \"Medical or Patient Reason for Not Screening Adult for Depression\":   [ObservationCancelled: code ~ \"Adult depression screening assessment\"] NoAdultScreen     with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter       such that NoAdultScreen.issued during day of QualifyingEncounter.period     where ( NoAdultScreen.notDoneReason ~ \"Depression screening declined (situation)\"         or NoAdultScreen.notDoneReason in \"Medical Reason\"     )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 28
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Has Adult Depression Screening"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Adult Depression Screening\":   exists ( [ObservationScreeningAssessment: \"Adult depression screening assessment\"] AdultScreening       with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter         such that AdultScreening.effective.toInterval ( ) 14 days or less on or before day of start of QualifyingEncounter.period           and AdultScreening.value is not null           and AdultScreening.status in { 'final', 'corrected' }   )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 29
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS2FHIRPCSDepressionScreenAndFollowUp"
            },
            {
              "url": "name",
              "valueString": "Denominator Exceptions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exceptions\":   ( exists \"Medical or Patient Reason for Not Screening Adolescent for Depression\"       and not \"Has Adolescent Depression Screening\"   )     or ( exists \"Medical or Patient Reason for Not Screening Adult for Depression\"         and not \"Has Adult Depression Screening\"     )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 30
            }
          ],
          "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": 31
            }
          ],
          "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": 32
            }
          ],
          "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": 33
            }
          ],
          "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": 34
            }
          ],
          "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": 35
            }
          ],
          "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": 36
            }
          ],
          "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": 37
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "prevalenceInterval"
            },
            {
              "url": "statement",
              "valueString": "/* @description: Returns an interval representing the normalized prevalence period of a given Condition. @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting  interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary. */ define fluent function prevalenceInterval(condition Choice<\"ConditionEncounterDiagnosis\", \"ConditionProblemsHealthConcerns\">): if condition.clinicalStatus ~ \"active\"   or condition.clinicalStatus ~ \"recurrence\"   or condition.clinicalStatus ~ \"relapse\" then   Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()] else     (end of condition.abatementInterval()) abatementDate     return if abatementDate is null then       Interval[start of condition.onset.toInterval(), abatementDate)     else       Interval[start of condition.onset.toInterval(), abatementDate]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 38
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "abatementInterval"
            },
            {
              "url": "statement",
              "valueString": "/* @description: Returns an interval representing the normalized abatement of a given Condition. @comment: If the abatement element of the Condition is represented as a DateTime, the result is an interval beginning and ending on that DateTime. If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The result is an interval from the date the patient turned that age to immediately before one year later. If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately before one year later than the date the patient turned the ending age of the quantity interval. */ define fluent function abatementInterval(condition Choice<\"ConditionEncounterDiagnosis\", \"ConditionProblemsHealthConcerns\">):  if condition.abatement is DateTime then    Interval[condition.abatement as DateTime, condition.abatement as DateTime]  else if condition.abatement is Quantity then   Interval[Patient.birthDate + (condition.abatement as Quantity),    Patient.birthDate + (condition.abatement as Quantity) + 1 year)  else if condition.abatement is Interval<Quantity> then    Interval[Patient.birthDate + (condition.abatement.low as Quantity),     Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)  else if condition.abatement is Interval<DateTime> then    Interval[condition.abatement.low, condition.abatement.high)  else null as Interval<DateTime>"
            },
            {
              "url": "displaySequence",
              "valueInteger": 39
            }
          ],
          "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 QICoreCommon",
          "resource": "https://madie.cms.gov/Library/QICoreCommon|4.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library CMD",
          "resource": "https://madie.cms.gov/Library/CumulativeMedicationDuration|6.0.000"
        },
        {
          "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 ConditionClinicalStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/condition-clinical"
        },
        {
          "type": "depends-on",
          "display": "Value set Encounter to Screen for Depression",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1916"
        },
        {
          "type": "depends-on",
          "display": "Value set Physical Therapy Evaluation",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1022"
        },
        {
          "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 Adolescent Depression Medications",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1567"
        },
        {
          "type": "depends-on",
          "display": "Value set Referral for Adolescent Depression",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1570"
        },
        {
          "type": "depends-on",
          "display": "Value set Follow Up for Adolescent Depression",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1569"
        },
        {
          "type": "depends-on",
          "display": "Value set Adult Depression Medications",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1566"
        },
        {
          "type": "depends-on",
          "display": "Value set Referral for Adult Depression",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1571"
        },
        {
          "type": "depends-on",
          "display": "Value set Follow Up for Adult Depression",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1568"
        },
        {
          "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 Bipolar Disorder",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.67.1.101.1.128"
        },
        {
          "type": "depends-on",
          "display": "Value set Medical Reason",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007"
        }
      ],
      "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": "Denominator Exceptions",
          "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",
            "birthDate",
            "birthDate.value",
            "url"
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1916"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1022"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment"
          ],
          "mustSupport": [
            "effective",
            "value"
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment"
          ],
          "mustSupport": [
            "code",
            "effective",
            "value",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "73831-0",
                  "display": "Adolescent depression screening assessment"
                }
              ]
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment"
          ],
          "mustSupport": [
            "code",
            "effective",
            "value",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "73832-8",
                  "display": "Adult depression screening assessment"
                }
              ]
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
          ],
          "mustSupport": [
            "medication",
            "dosageInstruction",
            "dispenseRequest",
            "dispenseRequest.expectedSupplyDuration",
            "dispenseRequest.quantity",
            "dispenseRequest.numberOfRepeatsAllowed",
            "dispenseRequest.numberOfRepeatsAllowed.value",
            "authoredOn",
            "authoredOn.value",
            "dispenseRequest.validityPeriod",
            "status",
            "status.value",
            "intent",
            "intent.value"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1567"
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
          ],
          "mustSupport": [
            "medication",
            "dosageInstruction",
            "dispenseRequest",
            "dispenseRequest.expectedSupplyDuration",
            "dispenseRequest.quantity",
            "dispenseRequest.numberOfRepeatsAllowed",
            "dispenseRequest.numberOfRepeatsAllowed.value",
            "authoredOn",
            "authoredOn.value",
            "dispenseRequest.validityPeriod",
            "status",
            "status.value",
            "intent",
            "intent.value"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1566"
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
          ],
          "mustSupport": [
            "medication.reference.value",
            "dosageInstruction",
            "dispenseRequest",
            "dispenseRequest.expectedSupplyDuration",
            "dispenseRequest.quantity",
            "dispenseRequest.numberOfRepeatsAllowed",
            "dispenseRequest.numberOfRepeatsAllowed.value",
            "authoredOn",
            "authoredOn.value",
            "dispenseRequest.validityPeriod",
            "status",
            "status.value",
            "intent",
            "intent.value"
          ]
        },
        {
          "type": "Medication",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"
          ],
          "mustSupport": [
            "id.value",
            "code"
          ]
        },
        {
          "type": "ServiceRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1570"
            }
          ]
        },
        {
          "type": "ServiceRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1571"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1569"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1568"
            }
          ]
        },
        {
          "type": "Coverage",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.67.1.101.1.128"
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observationcancelled"
          ],
          "mustSupport": [
            "code",
            "issued",
            "issued.value",
            "extension"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "73831-0",
                  "display": "Adolescent depression screening assessment"
                }
              ]
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observationcancelled"
          ],
          "mustSupport": [
            "code",
            "issued",
            "issued.value",
            "extension"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "73832-8",
                  "display": "Adult depression screening assessment"
                }
              ]
            }
          ]
        }
      ]
    }
  ],
  "extension": [
    {
      "id": "supplementalDataGuidance",
      "extension": [
        {
          "url": "guidance",
          "valueString": "For every patient evaluated by this measure also identify payer, race, ethnicity, and sex; SDE Ethnicity   SDE Payer   SDE Race   SDE Sex   "
        },
        {
          "url": "usage",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                "code": "supplemental-data",
                "display": "Supplemental Data"
              }
            ],
            "text": "Supplemental Data Guidance"
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance"
    },
    {
      "extension": [
        {
          "url": "term",
          "valueString": "Follow-Up Plan"
        },
        {
          "url": "definition",
          "valueMarkdown": "Documented follow-up for a positive depression screening must include one or more of the following:     -  Referral to a provider for additional evaluation and assessment to formulate a follow-up plan for a positive depression screen     -  Pharmacological interventions  (prescribed or active depression medication)    -  Other interventions or follow-up for the diagnosis or treatment of depression "
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm"
    },
    {
      "extension": [
        {
          "url": "term",
          "valueString": "Follow-Up Plan"
        },
        {
          "url": "definition",
          "valueMarkdown": "Documented follow-up for a positive depression screening must include one or more of the following:     -  Referral to a provider for additional evaluation and assessment to formulate a follow-up plan for a positive depression screen     -  Pharmacological interventions  (prescribed or active depression medication)    -  Other interventions or follow-up for the diagnosis or treatment of depression "
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm"
    },
    {
      "extension": [
        {
          "url": "term",
          "valueString": "Screening"
        },
        {
          "url": "definition",
          "valueMarkdown": "Completion of a clinical or diagnostic tool used to identify people at risk of developing or having a certain disease or condition, even in the absence of symptoms.  "
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm"
    },
    {
      "extension": [
        {
          "url": "term",
          "valueString": "Standardized Depression Screening Tool"
        },
        {
          "url": "definition",
          "valueMarkdown": "A normalized and validated depression screening tool developed for the patient population in which it is being utilized.  Examples of standardized depression screening tools include but are not limited to:  -  Adolescent Screening Tools (12-17 years)     -  Patient Health Questionnaire for Adolescents (PHQ-A)    -  Beck Depression Inventory-Primary Care Version (BDI-PC)    -  Mood Feeling Questionnaire (MFQ)    -  Center for Epidemiologic Studies Depression Scale (CES-D)    -  Patient Health Questionnaire (PHQ-9)    -  Pediatric Symptom Checklist (PSC-17)    -  Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD PHQ-2)  -  Adult Screening Tools (18 years and older)     -  Patient Health Questionnaire (PHQ-9)    -  Beck Depression Inventory (BDI or BDI-II)    -  Center for Epidemiologic Studies Depression Scale (CES-D)    - Depression Scale (DEPS)    -  Duke Anxiety-Depression Scale (DADS)    -  Geriatric Depression Scale (GDS)    -  Cornell Scale for Depression in Dementia (CSDD)    -  PRIME MD-PHQ-2     -  Hamilton Rating Scale for Depression (HAM-D)    -  Quick Inventory of Depressive Symptomatology Self-Report (QID-SR)    -  Computerized Adaptive Testing Depression Inventory (CAT-DI)    -  Computerized Adaptive Diagnostic Screener (CAD-MDD) -  Perinatal Screening Tools    -  Edinburgh Postnatal Depression Scale    -  Postpartum Depression Screening Scale    -  Patient Health Questionnaire 9 (PHQ-9)    -  Beck Depression Inventory    -  Beck Depression Inventory-II    -  Center for Epidemiologic Studies Depression Scale    -  Zung Self-rating Depression Scale "
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm"
    },
    {
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueReference": {
        "reference": "#effective-data-requirements"
      }
    }
  ],
  "url": "https://madie.cms.gov/Measure/CMS2FHIRPCSDepressionScreenAndFollowUp",
  "identifier": [
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            "display": "Short Name"
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      "system": "https://madie.cms.gov/measure/shortName",
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    {
      "use": "official",
      "type": {
        "coding": [
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            "code": "publisher",
            "display": "Publisher"
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      "system": "https://madie.cms.gov/measure/cmsId",
      "value": "2FHIR",
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        "display": "CMS"
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  "version": "0.4.001",
  "name": "CMS2FHIRPCSDepressionScreenAndFollowUp",
  "title": "Preventive Care and Screening: Screening for Depression and Follow-Up PlanFHIR",
  "status": "active",
  "experimental": false,
  "date": "2025-06-17T20:57:42+00:00",
  "publisher": "Centers for Medicare & Medicaid Services (CMS)",
  "contact": [
    {
      "telecom": [
        {
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          "value": "https://www.cms.gov/"
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  ],
  "description": "Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter",
  "usage": "The intent of the measure is to screen all patients for depression except those with previous diagnosis of bipolar disorder or depression. Patients who have ever been diagnosed with bipolar disorder or depression prior to the qualifying encounter will be excluded from the measure regardless of whether the diagnosis is active or not.  A depression screen is completed on the date of the encounter or up to 14 calendar days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan must be documented on the date of or up to two calendar days after the date of the encounter, such as referral to a provider for additional evaluation, pharmacological interventions, or other interventions for the treatment of depression. An example to illustrate the follow-up plan documentation timing: if the encounter is on a Monday from 3-4 pm (day 0) and the patient screens positive, the clinician has through anytime on Wednesday (day 2) to complete follow-up plan documentation.  This measure does not require documentation of a specific score, just whether results of the normalized and validated depression screening tool used are considered positive or negative. Each standardized screening tool provides guidance on whether a particular score is considered positive for depression.    The measure is not prescriptive in the specific screening tool being used and provides no hierarchy for acceptance of one tool over another. In the case where two screenings are documented on the same date/time with different results (one positive and one negative), the measure only assesses the most recent screening. Since both screenings are both considered the most recent, the patient will be captured in the numerator if the positive screening result also includes documentation of an intervention following the positive screen.   This eCQM is a patient-based measure. Depression screening is required once per measurement period, not at all encounters.  Screening Tools:  -  An age-appropriate, standardized, and validated depression screening tool must be used for numerator compliance.  -  The name of the age-appropriate standardized depression screening tool utilized must be documented in the medical record.  -  The depression screening must be reviewed and addressed by the provider, filing the code, on the date of the encounter. Positive pre-screening results indicating a patient is at high risk for self-harm should receive more urgent intervention as determined by the provider practice.  -  The screening should occur during a qualifying encounter or up to 14 calendar days prior to the date of the qualifying encounter.  -  The measure assesses the most recent depression screening completed either during the qualifying encounter or within the 14 calendar days prior to that encounter. Therefore, a clinician would not be able to complete another screening at the time of the encounter to count towards a follow-up, because that would serve as the most recent screening. In order to satisfy the follow-up requirement for a patient screening positively, the eligible clinician would need to provide one of the aforementioned follow-up actions, which does not include use of a standardized depression screening tool.  Follow-Up Plan: While there are many validated depression screening tools, they are not necessarily diagnostic tools. Patients with elevated depression screening scores should be followed by a clinician to evaluate whether a depression diagnosis is appropriate, but a medication and/or referral are not always indicated for a positive score. In these cases, a follow up plan is appropriate.   The follow-up plan MUST still be provided for and discussed with the patient during the qualifying encounter used to evaluate the numerator. However, documentation of the follow-up plan can occur up to two calendar days after the qualifying encounter, in accordance with the policies of an eligible clinician or provider’s practice or health system. All services should be documented during, or as soon as practicable, after the qualifying encounter in order to maintain an accurate medical record.  Examples of a follow-up plan include but are not limited to:   -  Referral to a provider or program for further evaluation for depression, for example, referral to a psychiatrist, psychiatric nurse practitioner, psychologist, clinical social worker, mental health counselor, or other mental health service such as family or group therapy, support group, depression management program, or other service for treatment of depression  -  Other interventions designed to treat depression such as behavioral health evaluation, psychotherapy, pharmacological interventions, or additional treatment options.   -  Exercise regimens, education counseling, coping support, and completion of a mental health crisis plan.   Should a patient screen positive for depression, a clinician should: -  Only order pharmacological intervention when appropriate and after sufficient diagnostic evaluation. However, for the purposes of this measure, additional screening and assessment during the qualifying encounter will not qualify as a follow-up plan. -  Opt to complete a suicide risk assessment when appropriate and based on individual patient characteristics. However, for the purposes of this measure, a suicide risk assessment or an additional screening using a standardized tool will not qualify as a follow-up plan.  This FHIR-based measure has been derived from the QDM-based measure: CMS2v15.   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 6.0.0 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).",
  "copyright": "This electronic clinical quality measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract # 75FCMC18D0027/ Task Order #: 75FCMC24F0144) with the American Institutes for Research (AIR) to develop this electronic measure. AIR is not responsible for any use of the Measure. AIR makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and AIR has no liability to anyone who relies on such measures or specifications.  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. AIR disclaims all liability for use or accuracy of any third-party codes contained in the specifications.  CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association. LOINC(R) is copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organization. ICD-10 is copyright 2024 World Health Organization. All Rights Reserved.",
  "approvalDate": "2023-08-30",
  "lastReviewDate": "2023-08-30",
  "effectivePeriod": {
    "start": "2026-01-01",
    "end": "2026-12-31"
  },
  "author": [
    {
      "name": "American Institutes for Research (AIR)",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.air.org"
        }
      ]
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "citation": "CITATION - American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. (2018). ACOG Committee Opinion Number 757: Screening for perinatal depression. Obstetrics and Gynecology, 132(5), e208-e212. doi: 10.1097/AOG.0000000000002927 "
    },
    {
      "type": "citation",
      "citation": "CITATION - American Psychiatric Association. (2017). Mental Health Disparities: Diverse Populations. Retrieved from https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts "
    },
    {
      "type": "citation",
      "citation": "CITATION - Borner, I., Braunstein, J. W., St. Victor, R., & Pollack, J. (2010). Evaluation of a 2-question screening tool for detecting depression in adolescents in primary care. Clinical Pediatrics, 49(10), 947-995. doi:10.1177/0009922810370203 "
    },
    {
      "type": "citation",
      "citation": "CITATION - Dadi, A. F., Miller, E. R., Bisetegn, T. A., & Mwanri, L. (2020). Global burden of antenatal depression and its association with adverse birth outcomes: an umbrella review. BMC public health, 20(1), 173. https://doi.org/10.1186/s12889-020-8293-9 "
    },
    {
      "type": "citation",
      "citation": "CITATION - Hazell Raine, K., Nath, S., Howard, L. M., Cockshaw, W., Boyce, P., Sawyer, E., & Thorpe, K. (2020). Associations between prenatal maternal mental health indices and mother-infant relationship quality 6 to 18 months' postpartum: A systematic review. Infant mental health journal, 41(1), 24–39. https://doi.org/10.1002/imhj.21825 "
    },
    {
      "type": "citation",
      "citation": "CITATION - Ka'apu, K., & Burnette, C. E. (2019). A Culturally Informed Systematic Review of Mental Health Disparities Among Adult Indigenous Men and Women of the USA: What is known?. British journal of social work, 49(4), 880–898. https://doi.org/10.1093/bjsw/bcz009 "
    },
    {
      "type": "citation",
      "citation": "CITATION - Lee, S. Y., Xue, Q. L., Spira, A. P., & Lee, H. B. (2014). Racial and ethnic differences in depressive subtypes and access to mental health care in the United States. Journal of affective disorders, 155, 130–137. https://doi.org/10.1016/j.jad.2013.10.037 "
    },
    {
      "type": "citation",
      "citation": "CITATION - Orhurhu, V., Olusunmade, M., Akinola, Y., Urits, I., Orhurhu, M. S., Viswanath, O., … Gill, J. S. (2019). Depression Trends in Patients with Chronic Pain: An Analysis of the Nationwide Inpatient Sample. Pain physician, 22(5), E487–E494. "
    },
    {
      "type": "citation",
      "citation": "CITATION - Pratt, L. A., & Brody, D. J. (2014). Depression in the U.S. household population, 2009-2012. NCHS Data Brief No. 172. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db172.pdf "
    },
    {
      "type": "citation",
      "citation": "CITATION - Siu, A. L., & USPSTF. (2016). Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement. Journal of the American Medical Association, 315(4), 380-387. doi:10.1001/jama.2015.18392. "
    },
    {
      "type": "citation",
      "citation": "CITATION - Siu, A. L., on behalf of USPSTF. (2016). Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 164(5), 360-366. doi:10.7326/M15-2957 "
    },
    {
      "type": "citation",
      "citation": "CITATION - Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm "
    },
    {
      "type": "citation",
      "citation": "CITATION - Trangle, M., Gursky, J., Haight, R., Hardwig, J., Hinnenkamp, T., Kessler, D.,… Myszkowski, M. (2016). Adult depression in primary care. Bloomington, MN: Institute for Clinical Systems Improvement. Retrieved from https://www.icsi.org/guideline/depression/ "
    },
    {
      "type": "citation",
      "citation": "CITATION - U.S. Department of Health and Human Services. (2014). Healthy People 2020: Mental health and mental disorders. Washington, DC: U.S. Department of Health and Human Services. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=28 "
    },
    {
      "type": "citation",
      "citation": "CITATION - U.S. Preventive Services Task Force. (2019). Interventions to Prevent Perinatal Depression: US Preventive Services Task Force Recommendation Statement. JAMA, 321(6):580–587. doi:10.1001/jama.2019.0007 "
    },
    {
      "type": "citation",
      "citation": "CITATION - Vibhakar, V., Allen, L. R., Gee, B., & Meiser-Stedman, R. (2019). A systematic review and meta-analysis on the prevalence of depression in children and adolescents after exposure to trauma. Journal of affective disorders, 255, 77–89. https://doi.org/10.1016/j.jad.2019.05.005 "
    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS2FHIRPCSDepressionScreenAndFollowUp"
  ],
  "disclaimer": "These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.  THE MEASURES 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": "Depression affects more than two hundred sixty million people across the world and is a leading cause of disability, with a variety of depressive disorders that are independent risk factors for chronic diseases, such as cardiovascular disease and diabetes, lending screening for depression as paramount to identify depressive disorders that can affect the most vulnerable populations (Costantini et al., 2021). Results from a 2018 U.S. survey indicated that 14.4 percent of adolescents (3.5 million adolescents) had a major depressive episode (MDE) in the past year, with nine percent of adolescents (2.4 million adolescents) having one MDE with severe impairment (Substance Abuse and Mental Health Services Administration, 2019). The odds of a diagnosis of depression are believed to be 2.6 times greater for children and adolescents exposed to trauma as compared to those unexposed or less exposed (Vibhakar et al., 2019). Children and teens with major depressive disorder (MDD) have been found to have difficulty carrying out their daily activities, relating to others, growing up healthy, and are at an increased risk of suicide (Siu on behalf of the U.S. Preventive Services Task Force [USPSTF], 2016).   The same 2018 study indicated that 7.2 percent of adults aged 18 or older (17.7 million adults) had at least one MDE with 4.7 percent of adults (11.5 million adults) having one MDE with severe impairment in the past year (Substance Abuse and Mental Health Services Administration, 2019). Moreover, it is estimated 22.9 percent of adult patients with chronic pain (2.2 million adults) were diagnosed with comorbid depression from 2011 to 2015, with an upward trend of prevalence among Black Americans, patients aged 65 to 84 years old, Medicare and Medicaid insured patients, and patients from zip code areas with low annual household incomes (Orhurhu et al., 2019).   Depression and other mood disorders, such as bipolar disorder and anxiety disorders, especially during the perinatal period, can have devastating effects on women, infants, and families (American College of Obstetricians and Gynecologists, 2018). It's estimated that the global prevalence of antenatal (or perinatal) depression ranges from 15 to 65 percent, with current or previous exposure to abuse and violence, lack of social support, and family history of mental disorders being risk factors. Depressive symptoms measured during pregnancy have been shown to influence the quality of the postpartum mother-infant relationship (Hazell Raine et al., 2020). Additionally, the risk of low birth weight and preterm birth is higher among infants born from depressed mothers (Dadi, Miller, Bisetegn, & Mwanri, 2020).  Negative outcomes associated with depression make it crucial to screen in order to identify and treat depression in its early stages. Multiple social costs of depression have been identified, such as reduced educational achievements, poor financial success and role performance, higher amount of days out of role, and increased risk of job loss (Costantini et al., 2021). Depression also imposes significant economic burden through direct and indirect costs, supporting the need for regular depression screening. \"In the United States, an estimated $22.8 billion was spent on depression treatment in 2009, and lost productivity cost an additional estimated $23 billion in 2011\" (Siu & USPSTF, 2016, p. 383-384).   Numerous studies have found significant disparities in depression prevalence and treatment among racial/ethnic minorities. One study revealed that Indigenous adults are at a high risk for posttraumatic stress disorder, depression, suicide, substance use disorder, and concurrent behavioral health disorders secondary to these initial health problems (Ka’apu and Burnette, 2019). Additionally, though rates of depression are lower among Blacks and Hispanics than among whites, depression among Blacks and Hispanics is likely to be more recurrent. Furthermore, 48 percent of whites receive mental health services, compared to just 31 percent of Blacks and Hispanics, and 22 percent of Asians (American Psychiatric Association, 2017). Asian Americans and Black Americans are also significantly more likely to utilize emergency rooms for depression treatment, which contributes to inconsistent follow-up care (Lee et al., 2014).   While primary care providers (PCPs) serve as the first line of defense in the detection of depression, studies show that PCPs fail to recognize up to 46 percent of depressed patients (Borner et al., 2010). \"In nationally representative U.S. surveys, about eight percent of adolescents reported having major depression in the past year. Only 36 percent to 44 percent of children and adolescents with depression receive treatment, suggesting that a majority of depressed youth are undiagnosed and untreated\" (Siu on behalf of USPSTF, 2016). Furthermore, evidence supports that screening for depression in pregnant and postpartum women is of moderate net benefit, and treatment options for positive depression screening should be available for patients twelve and older including pregnant and postpartum women.   This measure seeks to align with USPSTF clinical guideline recommendations as well as the Healthy People 2030 recommendation to increase the proportion of adolescents and adults who are screened for depression and if positive, receive appropriate treatment (U.S. Preventive Services Task Force, 2016; U.S. Department of Health and Human Services, 2020).  For patients with depression, rescreening has been shown to be an effective tool for measuring response to therapy, therefore influencing appropriate care adjustments in the treatment of depression (Anderson et al., 2002). Chen et al. noted that when patients were re-administered a screening tool after at least eight weeks after starting treatment, their \"score gave primary care physicians a clear idea about the nature of patients' depressive symptoms and gave both the patient and the physician an indication of treatment progress\" (Chen et al., 2006).",
  "clinicalRecommendationStatement": "Adolescent Recommendation (12-18 years): \"The USPSTF recommends screening for MDD in adolescents aged 12 to 18 years. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation)\" (Siu on behalf of USPSTF, 2016).  Adult Recommendation (18 years and older): \"The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation)\" (Siu & USPSTF, 2016).  “The USPSTF recommends that clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions (B recommendation)” (U.S. Preventive Services Task Force, 2019).   The American College of Obstetricians and Gynecologists (ACOG) provides the following recommendation: \"All obstetrician–gynecologists and other obstetric care providers should complete a full assessment of mood and emotional well-being (including screening for postpartum depression and anxiety with a validated instrument) during the comprehensive postpartum visit for each patient\" (American College of Obstetricians and Gynecologists, 2018).   The Institute for Clinical Systems Improvement (ICSI) health care guideline, Adult Depression in Primary Care, provides the following recommendations: 1. \"Clinicians should routinely screen all adults for depression using a standardized instrument.\" 2. \"Clinicians should establish and maintain follow-up with patients.\" 3. \"Clinicians should screen and monitor depression in pregnant and post-partum women\" (Trangle et al., 2016).",
  "group": [
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      "description": "Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter",
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          "description": "All patients aged 12 years and older at the beginning of the measurement period with at least one qualifying encounter during the measurement period",
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          "description": "Patients who have ever been diagnosed with bipolar disorder at any time prior to the qualifying encounter",
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          "id": "Numerator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Patients screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter or an active depression medication overlaps the date of the qualifying encounter.",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        },
        {
          "id": "DenominatorException_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exception",
                "display": "Denominator Exception"
              }
            ]
          },
          "description": "Patient Reason(s) Patient refuses to participate in or complete the depression screening OR Medical Reason(s)  Documentation of medical reason for not screening patient for depression (e.g., cognitive, functional, or motivational limitations that may impact accuracy of results; patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient's health status)",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exceptions"
          }
        }
      ]
    }
  ],
  "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"
      }
    }
  ]
}