Metadata
Title HIV ScreeningFHIR
Version 1.1.000
Short Name CMS349FHIR
GUID (Version Independent) urn:uuid:40b617bf-3054-4663-bf9c-a15417c9a7dc
GUID (Version Specific) urn:uuid:2ecafb2e-b48a-44e6-9e10-4a9db778cf97
CMS Identifier 349FHIR
Effective Period 2026-01-01 through 2026-12-31
Steward (Publisher) Centers for Disease Control and Prevention (CDC)
Developer Centers for Disease Control and Prevention (CDC)
Description

Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for human immunodeficiency virus (HIV)
Copyright

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. CDC 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) copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved.
Disclaimer

The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE 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

HIV is a communicable infection that leads to a progressive disease with a long asymptomatic period. Although progress has been made with an overall 12% decline in estimated HIV infections from 2018 to 2022, CDC estimated 31,800 new HIV infections in the United States in 2022 (Centers for Disease Control and Prevention, 2024a). Without treatment, most persons develop acquired immunodeficiency syndrome (AIDS) within 10 years of HIV infection. Antiretroviral therapy (ART) delays this progression and increases the length of survival, but it is most effective when initiated during the asymptomatic phase. Persons living with HIV who use ART and achieve viral suppression can have a nearly normal life expectancy (Samji et al., 2013). The Department of Health and Human Services (DHHS) Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents recommends immediate antiretroviral therapy for all HIV-infected individuals, regardless of CD4 count at diagnosis, to reduce the risk of disease progression (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022).

CDC estimates that, in 2022, approximately 13% of the 1.2 million adults and adolescents living with HIV infection in the United States were unaware of their infection (CDC, 2024a). Among persons diagnosed with HIV in 2022, approximately 21% were diagnosed with Stage 3 HIV (AIDS) at the time of HIV diagnosis (CDC, 2024b), which is when there is a CD4 lymphocyte count of less than 200 cells/mm3 or a CD4 percentage of total lymphocytes of less than 14 or documentation of AIDS-defining condition at diagnosis (CDC, 2024b). HIV screening identifies infected persons who were previously unaware of their infection, which enables them to seek medical and social services that can improve their health and the quality and length of their lives. Additionally, using ART with high levels of medication adherence has been shown to substantially reduce the risk of HIV transmission (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022).

Based on the Behavioral Risk Factor Surveillance System (BRFSS), the percentage of ever tested for HIV increased from 42.9% in 2011 to 45.9% in 2017. Despite this increase, less than half of US adults have ever been tested for HIV over ten years after CDC's recommendations (Patel et al., 2020).
Clinical Recommendation Statement

The US Preventive Services Task Force recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened (A Recommendation) (Owens, et al., 2019).

Since 2006, the CDC has recommended routine opt-out HIV screening (i.e., patient is notified that testing will be performed unless the patient declines) in healthcare facilities of adolescents and adults 13-64 years of age and HIV diagnostic testing of adolescents and adults with clinical signs or symptoms consistent with HIV infection (Centers for Disease Control and Prevention, 2006).
Citation

Centers for Disease Control and Prevention. (2024a). HIV Surveillance Supplemental Report: Estimated HIV Incidence and Prevalence in the United States, 2018--2022. HIV Surveillance Supplemental Report 2024;29 (No. 1). Retrieved from https://stacks.cdc.gov/view/cdc/156513.
Citation

Centers for Disease Control and Prevention. (2024b). HIV Surveillance Supplemental Report: Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data United States and 6 Territories and Freely Associated States, 2022. HIV Surveillance Supplemental Report 2024;29 (No. 2). Retrieved from https://stacks.cdc.gov/view/cdc/156511.
Citation

Centers for Disease Control and Prevention. (2006). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health care settings. Morbidity and Mortality Weekly Report, 55(RR-14), 1-17.
Citation

Owens, on behalf of the U.S. Preventive Task Force. (2019). Screening for HIV: US Preventive Services Task Force Recommendation Statement. JAMA, 321(23), 2326-2336.
Citation

Panel on Antiretroviral Guidelines for Adults and Adolescents. (2022). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Retrieved from https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf
Citation

Patel, D., Johnson, C.H., Krueger, A. et al. (2019). Trends in HIV Testing Among US Adults, Aged 18--64 Years, 2011--2017. AIDS and Behavior, 24(2), 532. https://doi.org/10.1007/s10461-019-02689-0'
Citation

Samji, H., Cescon, A., Hogg, R. S., Modur, S. P., Althoff, K. N., Buchacz, K., ... & North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA. (2013). Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One, 8(12), e81355.
Guidance (Usage) This measure evaluates the proportion of patients aged 15 to 65 at the start of the measurement period who have documentation of having received an HIV test at least once on or after their 15th birthday and before their 66th birthday. In order to satisfy the measure, the reporting provider must have documentation of the administration of a laboratory or point of care (POC) test present in the patient's medical record. In cases where the HIV test was performed elsewhere, providers cannot rely on patient attestation or self-report to meet the measure requirements, as previous research has shown that patient self-report is an unreliable indicator of previous HIV testing history. Rather, providers must request documentation of those test results. If such documentation is not available, the patient should be considered still eligible for HIV screening. If such documentation is available, but cannot be provided in a standardized, structured format (such that the laboratory or point of care (POC) test and results can be readily incorporated as structured data within the EHR), providers should enter the information into their EHR as a laboratory test in a manner consistent with the EHR in use. If the specific Human Immunodeficiency Virus (HIV) Laboratory Test LOINC code of the test is not known, the entry should use the more generic code LOINC panel code \[75622-1\]. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure CMS349v8. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).
Measure Group (Rate) (ID: Group_1)
Basis boolean
Scoring Proportion
Improvement Notation Increased score indicates improvement
Type Process
Initial Population ID: InitialPopulation_1
Description:

Patients 15 to 65 years of age at the start of the measurement period without an HIV diagnosis prior to the start of the measurement period AND who had at least one outpatient visit during the day of the measurement period

Criteria: Initial Population
Denominator ID: Denominator_1
Description:

Equals Initial Population

Criteria: Denominator
Denominator Exclusion ID: DenominatorExclusion_1
Description:

Patients diagnosed with HIV prior to the day of the start of the measurement period

Criteria: Denominator Exclusions
Denominator Exception ID: DenominatorException_1
Description:

Patients who die on or before the end of the day of the measurement period

Criteria: Denominator Exceptions
Numerator ID: Numerator_1
Description:

Patients with documentation of an HIV test performed on or after their 15th birthday and before their 66th birthday

Criteria: Numerator
For every patient evaluated by this measure also identify payer, race, ethnicity and sex
Supplemental Data Elements
Supplemental Data Element ID: sde-ethnicity
Usage Code: Supplemental Data
Description: SDE Ethnicity
Logic Definition: SDE Ethnicity
Supplemental Data Element ID: sde-payer
Usage Code: Supplemental Data
Description: SDE Payer
Logic Definition: SDE Payer
Supplemental Data Element ID: sde-race
Usage Code: Supplemental Data
Description: SDE Race
Logic Definition: SDE Race
Supplemental Data Element ID: sde-sex
Usage Code: Supplemental Data
Description: SDE Sex
Logic Definition: SDE Sex
Measure Logic
Primary Library https://madie.cms.gov/Library/CMS349FHIRHIVScreening
Contents Population Criteria
Logic Definitions
Terminology
Dependencies
Data Requirements
Parameters
Population Criteria
Measure Group (Rate) (ID: Group_1)
Initial Population 
define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") in Interval[15, 65]
    and exists "Qualifying Encounters"
Definition
Denominator 
define "Denominator":
  "Initial Population"
Definition
Denominator Exclusion 
define "Denominator Exclusions":
  exists ( ( [ConditionProblemsHealthConcerns: "HIV"]
      union [ConditionEncounterDiagnosis: "HIV"] ) HIVDiagnosis
      where HIVDiagnosis.onset.toInterval ( ) starts before day of start of "Measurement Period"
        and HIVDiagnosis.isVerified ( )
  )
Definition
Denominator Exception 
define "Denominator Exceptions":
  "Patient Expired"
Definition
Numerator 
define "Numerator":
  ( "Has HIV Test Performed" )
Definition
Logic Definitions
Logic Definition Library Name: SupplementalDataElements 
define "SDE Sex":
  case
    when Patient.sex() = '248153007' then "Male (finding)"
    when Patient.sex() = '248152002' then "Female (finding)"
    else null
  end
Logic Definition Library Name: SupplementalDataElements 
define "SDE Payer":
  [USQualityCore.Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }
Logic Definition Library Name: SupplementalDataElements 
define "SDE Ethnicity":
  (Patient.ethnicity()) E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }
Logic Definition Library Name: SupplementalDataElements 
define "SDE Race":
  (Patient.race()) R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }
Logic Definition Library Name: FHIRCommon 
/*
@description: Returns the single extension (if present) on the given resource with the specified url.
@comment: This function uses singleton from to ensure that a run-time exception is thrown if there
is more than one extension on the given resource with the specified url.
*/
define fluent function ext(domainResource DomainResource, url String):
  singleton from domainResource.exts(url)
Logic Definition Library Name: FHIRCommon 
/*
@description: Returns any extensions defined on the given resource with the specified url
*/
define fluent function exts(domainResource DomainResource, url String):
  domainResource.extension E
    where E.url = url
    return E
Logic Definition Library Name: FHIRCommon 
/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range 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 FHIR, allowing this function to be used across any resource.

The input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.
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 Period, the result is a DateTime Interval.
If the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.
If the input is an instant, the result is a DateTime Interval beginning and ending on that instant.
If the input is a string, an error is raised indicating a single interval cannot be computed from a string.
If the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,
and ending immediately prior to when the patient was the given Age plus one year.
If the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given
by the low end of the Range, and ending immediately prior to when the patient was the Age given by the
high end of the Range plus one year.

NOTE: Due to the
complexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used
with a Timing or String.
*/
define fluent function toInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):
  case
    when choice is FHIR.dateTime then
      Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]
    when choice is FHIR.Period then
      FHIRHelpers.ToInterval(choice as FHIR.Period)
    when choice is FHIR.instant then
      Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]
    when choice is FHIR.Age then
      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),
        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)
    when choice is FHIR.Range then
      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),
        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)
    when choice is FHIR.Timing then
      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported')
    when choice is FHIR.string then
      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')
    else
      null as Interval<DateTime>
  end
Logic Definition Library Name: FHIRCommon 
/*
@description: Returns the single extension (if present) on the given element with the specified url.
@comment: This function uses singleton from to ensure that a run-time exception is thrown if there
is more than one extension on the given element with the specified url.
*/
define fluent function ext(element Element, url String):
  singleton from element.exts(url)
Logic Definition Library Name: FHIRCommon 
/*
@description: Returns any extensions defined on the given element with the specified url.
*/
define fluent function exts(element Element, url String):
  element.extension E
    where E.url = url
    return E
Logic Definition Library Name: CMS349FHIRHIVScreening 
define "SDE Sex":
  SDE."SDE Sex"
Logic Definition Library Name: CMS349FHIRHIVScreening 
define "Has HIV Test Performed":
  exists ( ["LaboratoryResultObservation": "Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag)"]
    union ["LaboratoryResultObservation": "HIV 1 and 2 tests - Meaningful Use set"] ) HIVTest
    where HIVTest.value is not null
      and AgeInYearsAt(date from start of HIVTest.effective.toInterval()) in Interval[15, 65]
      and HIVTest.effective.toInterval ( ) starts before day of end of "Measurement Period"
      and ( HIVTest.status = 'final'
          or HIVTest.status = 'amended'
          or HIVTest.status = 'corrected'
      )
Logic Definition Library Name: CMS349FHIRHIVScreening 
define "Numerator":
  ( "Has HIV Test Performed" )
Logic Definition Library Name: CMS349FHIRHIVScreening 
define "Qualifying Encounters":
  ( ["Encounter": "Preventive Care Services, Initial Office Visit, 0 to 17"]
    union ["Encounter": "Preventive Care Services-Initial Office Visit, 18 and Up"]
    union ["Encounter": "Preventive Care, Established Office Visit, 0 to 17"]
    union ["Encounter": "Preventive Care Services - Established Office Visit, 18 and Up"]
    union ["Encounter": "Office Visit"] ) Encounter
    where Encounter.period during day of "Measurement Period"
      and Encounter.status = 'finished'
Logic Definition Library Name: CMS349FHIRHIVScreening 
define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") in Interval[15, 65]
    and exists "Qualifying Encounters"
Logic Definition Library Name: CMS349FHIRHIVScreening 
define "Denominator":
  "Initial Population"
Logic Definition Library Name: CMS349FHIRHIVScreening 
define "SDE Payer":
  SDE."SDE Payer"
Logic Definition Library Name: CMS349FHIRHIVScreening 
define "SDE Ethnicity":
  SDE."SDE Ethnicity"
Logic Definition Library Name: CMS349FHIRHIVScreening 
define "Denominator Exclusions":
  exists ( ( [ConditionProblemsHealthConcerns: "HIV"]
      union [ConditionEncounterDiagnosis: "HIV"] ) HIVDiagnosis
      where HIVDiagnosis.onset.toInterval ( ) starts before day of start of "Measurement Period"
        and HIVDiagnosis.isVerified ( )
  )
Logic Definition Library Name: CMS349FHIRHIVScreening 
define "SDE Race":
  SDE."SDE Race"
Logic Definition Library Name: CMS349FHIRHIVScreening 
define "Patient Expired":
  Patient.deceased on or before day of end of "Measurement Period"
Logic Definition Library Name: CMS349FHIRHIVScreening 
define "Denominator Exceptions":
  "Patient Expired"
Logic Definition Library Name: CMS349FHIRHIVScreening 
/*
@description: Returns true if the given condition either has no verification status or has a verification status of confirmed, unconfirmed, provisional, or differential
*/


define fluent function isVerified(condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):
  condition.verificationStatus is not null implies ( condition.verificationStatus ~ Status."confirmed"
      or condition.verificationStatus ~ Status."unconfirmed"
      or condition.verificationStatus ~ Status."provisional"
      or condition.verificationStatus ~ Status."differential"
  )
Logic Definition Library Name: FHIRHelpers 
define function ToString(value string): value.value
Logic Definition Library Name: FHIRHelpers 
define function ToString(value uri): value.value
Logic Definition Library Name: FHIRHelpers 
define function ToDate(value date): value.value
Logic Definition Library Name: FHIRHelpers 
define function ToDateTime(value dateTime): value.value
Logic Definition Library Name: FHIRHelpers 
/*
@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]
Logic Definition Library Name: FHIRHelpers 
define function ToDateTime(value instant): value.value
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) 
value to a CQL Quantity
@comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity
has a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`)
an error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used.
@seealso: ToCalendarUnit
*/
define function ToQuantity(quantity FHIR.Quantity):
    case
        when quantity is null then null
        when quantity.value is null then null
        when quantity.comparator is not null then
            Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')
        when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'
              or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then
            System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }
        else
            Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')
    end
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts a UCUM definite duration unit to a CQL calendar duration
unit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) 
topic of the CQL specification.
@comment: Note that for durations above days (or weeks), the conversion is understood to be approximate
*/
define function ToCalendarUnit(unit System.String):
    case unit
        when 'ms' then 'millisecond'
        when 's' then 'second'
        when 'min' then 'minute'
        when 'h' then 'hour'
        when 'd' then 'day'
        when 'wk' then 'week'
        when 'mo' then 'month'
        when 'a' then 'year'
        else unit
    end
Logic Definition Library Name: FHIRHelpers 
define function ToString(value ObservationStatus): value.value
Logic Definition Library Name: FHIRHelpers 
define function ToString(value EncounterStatus): value.value
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }
Logic Definition Library Name: FHIRHelpers 
/*
@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
        }
Logic Definition Library Name: USCoreCommon 
/*
@description: Returns the sex element as defined for the USCore patient profile
*/
define fluent function sex(patient Patient):
  patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex').value as FHIR.code
Logic Definition Library Name: USCoreCommon 
define fluent function ethnicity(patient Patient):
  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity')) E
    return {
      ombCategory: E.ext('ombCategory').value as FHIR.Coding,
      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,
      text: E.ext('text').value as FHIR.string
    }
Logic Definition Library Name: USCoreCommon 
define fluent function race(patient Patient):
  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-race')) E
    return {
      ombCategory: (E.exts('ombCategory')) o return o.value as FHIR.Coding,
      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,
      text: E.ext('text').value as FHIR.string
    }
Terminology
Code System Description: Code system SNOMEDCT
Resource: SNOMED CT (all versions)
Canonical URL: http://snomed.info/sct
Code System Description: Code system LOINC
Resource: Logical Observation Identifiers, Names and Codes (LOINC)
Canonical URL: http://loinc.org
Code System Description: Code system ConditionVerificationStatusCodes
Resource: ConditionVerificationStatus
Canonical URL: http://terminology.hl7.org/CodeSystem/condition-ver-status
Value Set Code System Description: Value set Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag)
Resource: HIV Lab Tests
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1056.50
Value Set Description: Value set Preventive Care Services, Initial Office Visit, 0 to 17
Resource: Preventive Care Services, Initial Office Visit, 0 to 17
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022
Value Set Description: Value set Preventive Care Services-Initial Office Visit, 18 and Up
Resource: Preventive Care Services Initial Office Visit, 18 and Up
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
Value Set Description: Value set Preventive Care, Established Office Visit, 0 to 17
Resource: Preventive Care, Established Office Visit, 0 to 17
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024
Value Set Description: Value set Preventive Care Services - Established Office Visit, 18 and Up
Resource: Preventive Care Services Established Office Visit, 18 and Up
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
Value Set Description: Value set Office Visit
Resource: Office Visit
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
Value Set Description: Value set Payer Type
Resource: Payer Type
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Value Set Description: Value set HIV
Resource: HIV
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003
Direct Reference Code Display: Male (finding)
Code: 248153007
System: http://snomed.info/sct
Direct Reference Code Display: Female (finding)
Code: 248152002
System: http://snomed.info/sct
Direct Reference Code Display: HIV 1 and 2 tests - Meaningful Use set
Code: 75622-1
System: http://loinc.org
Direct Reference Code Display: confirmed
Code: confirmed
System: http://terminology.hl7.org/CodeSystem/condition-ver-status
Direct Reference Code Display: unconfirmed
Code: unconfirmed
System: http://terminology.hl7.org/CodeSystem/condition-ver-status
Direct Reference Code Display: provisional
Code: provisional
System: http://terminology.hl7.org/CodeSystem/condition-ver-status
Direct Reference Code Display: differential
Code: differential
System: http://terminology.hl7.org/CodeSystem/condition-ver-status
Dependencies
Dependency Description: USQualityCore model information
Resource: https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild
Canonical URL: https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild
Dependency Description: USCore model information
Resource: http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived
Canonical URL: http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived
Dependency Description: FHIR model information
Resource: http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1
Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1
Dependency Description: Library SDE
Resource: SupplementalDataElements version: 6.1.000
Canonical URL: https://madie.cms.gov/Library/SupplementalDataElements|6.1.000
Dependency Description: Library FHIRHelpers
Resource: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1
Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1
Dependency Description: Library USCommon
Resource: http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot
Canonical URL: http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot
Dependency Description: Library FHIRCommon
Resource: http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0
Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0
Dependency Description: Library Status
Resource: Status version: 2.1.000
Canonical URL: https://madie.cms.gov/Library/Status|2.1.000
Data Requirements
Data Requirement Type: Patient
Profile(s): http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient
Must Support Elements: ombCategory, detailed, text, deceased
Data Requirement Type: Patient
Profile(s): Patient
Must Support Elements: birthDate
Data Requirement Type: Observation
Profile(s): http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-lab
Must Support Elements: code, value, effective, status
Code Filter(s):
Path: code
ValueSet: HIV Lab Tests
Data Requirement Type: Observation
Profile(s): http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-lab
Must Support Elements: code, value, effective, status
Code Filter(s):
Path: code
Code(s): LOINC: 75622-1 (HIV 1 and 2 tests - Meaningful Use set)
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type, period, status
Code Filter(s):
Path: type
ValueSet: Preventive Care Services, Initial Office Visit, 0 to 17
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type, period, status
Code Filter(s):
Path: type
ValueSet: Preventive Care Services Initial Office Visit, 18 and Up
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type, period, status
Code Filter(s):
Path: type
ValueSet: Preventive Care, Established Office Visit, 0 to 17
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type, period, status
Code Filter(s):
Path: type
ValueSet: Preventive Care Services Established Office Visit, 18 and Up
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type, period, status
Code Filter(s):
Path: type
ValueSet: Office Visit
Data Requirement Type: Coverage
Profile(s): http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-coverage
Must Support Elements: type, period
Code Filter(s):
Path: type
ValueSet: Payer Type
Data Requirement Type: Condition
Profile(s): http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: HIV
Data Requirement Type: Condition
Profile(s): http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: HIV
Parameters
Name Use Card. Type Documentation
Measurement Period In 0..1 Period
SDE Sex Out 0..1 Coding
Numerator Out 0..1 boolean
Denominator Out 0..1 boolean
SDE Payer Out 0..* Resource
Initial Population Out 0..1 boolean
SDE Ethnicity Out 0..1 Resource
Denominator Exclusions Out 0..1 boolean
SDE Race Out 0..1 Resource
Denominator Exceptions Out 0..1 boolean
Generated using version 0.5.4 of the sample-content-ig Liquid templates
<status value="active"/> <experimental value="false"/> <date value="2026-01-16T18:18:13+00:00"/> <publisher value="Centers for Disease Control and Prevention (CDC)"/> <contact> <telecom> <system value="url"/> <value value="www.cdc.gov/hiv/"/> </telecom> </contact> <description value="Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for human immunodeficiency virus (HIV) "/> <usage value="This measure evaluates the proportion of patients aged 15 to 65 at the start of the measurement period who have documentation of having received an HIV test at least once on or after their 15th birthday and before their 66th birthday. In order to satisfy the measure, the reporting provider must have documentation of the administration of a laboratory or point of care (POC) test present in the patient's medical record. In cases where the HIV test was performed elsewhere, providers cannot rely on patient attestation or self-report to meet the measure requirements, as previous research has shown that patient self-report is an unreliable indicator of previous HIV testing history. Rather, providers must request documentation of those test results. If such documentation is not available, the patient should be considered still eligible for HIV screening. If such documentation is available, but cannot be provided in a standardized, structured format (such that the laboratory or point of care (POC) test and results can be readily incorporated as structured data within the EHR), providers should enter the information into their EHR as a laboratory test in a manner consistent with the EHR in use. If the specific Human Immunodeficiency Virus (HIV) Laboratory Test LOINC code of the test is not known, the entry should use the more generic code LOINC panel code \[75622-1\]. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure CMS349v8. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html). "/> <copyright value="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. CDC 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) copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT\[R\]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved. "/> <effectivePeriod> <start value="2026-01-01"/> <end value="2026-12-31"/> </effectivePeriod> <author> <name value="Centers for Disease Control and Prevention (CDC)"/> <telecom> <system value="url"/> <value value="www.cdc.gov/hiv/"/> </telecom> </author> <relatedArtifact> <type value="citation"/> <citation value="Centers for Disease Control and Prevention. (2024a). HIV Surveillance Supplemental Report: Estimated HIV Incidence and Prevalence in the United States, 2018--2022. HIV Surveillance Supplemental Report 2024;29 (No. 1). Retrieved from https://stacks.cdc.gov/view/cdc/156513. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Centers for Disease Control and Prevention. (2024b). HIV Surveillance Supplemental Report: Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data United States and 6 Territories and Freely Associated States, 2022. HIV Surveillance Supplemental Report 2024;29 (No. 2). Retrieved from https://stacks.cdc.gov/view/cdc/156511. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Centers for Disease Control and Prevention. (2006). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health care settings. Morbidity and Mortality Weekly Report, 55(RR-14), 1-17. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Owens, on behalf of the U.S. Preventive Task Force. (2019). Screening for HIV: US Preventive Services Task Force Recommendation Statement. JAMA, 321(23), 2326-2336. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Panel on Antiretroviral Guidelines for Adults and Adolescents. (2022). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Retrieved from https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Patel, D., Johnson, C.H., Krueger, A. et al. (2019). Trends in HIV Testing Among US Adults, Aged 18--64 Years, 2011--2017. AIDS and Behavior, 24(2), 532. https://doi.org/10.1007/s10461-019-02689-0' "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Samji, H., Cescon, A., Hogg, R. S., Modur, S. P., Althoff, K. N., Buchacz, K., ... \& North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA. (2013). Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One, 8(12), e81355. "/> </relatedArtifact> <library value="https://madie.cms.gov/Library/CMS349FHIRHIVScreening"/> <disclaimer value="The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE 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 value="HIV is a communicable infection that leads to a progressive disease with a long asymptomatic period. Although progress has been made with an overall 12% decline in estimated HIV infections from 2018 to 2022, CDC estimated 31,800 new HIV infections in the United States in 2022 (Centers for Disease Control and Prevention, 2024a). Without treatment, most persons develop acquired immunodeficiency syndrome (AIDS) within 10 years of HIV infection. Antiretroviral therapy (ART) delays this progression and increases the length of survival, but it is most effective when initiated during the asymptomatic phase. Persons living with HIV who use ART and achieve viral suppression can have a nearly normal life expectancy (Samji et al., 2013). The Department of Health and Human Services (DHHS) Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents recommends immediate antiretroviral therapy for all HIV-infected individuals, regardless of CD4 count at diagnosis, to reduce the risk of disease progression (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022). CDC estimates that, in 2022, approximately 13% of the 1.2 million adults and adolescents living with HIV infection in the United States were unaware of their infection (CDC, 2024a). Among persons diagnosed with HIV in 2022, approximately 21% were diagnosed with Stage 3 HIV (AIDS) at the time of HIV diagnosis (CDC, 2024b), which is when there is a CD4 lymphocyte count of less than 200 cells/mm3 or a CD4 percentage of total lymphocytes of less than 14 or documentation of AIDS-defining condition at diagnosis (CDC, 2024b). HIV screening identifies infected persons who were previously unaware of their infection, which enables them to seek medical and social services that can improve their health and the quality and length of their lives. Additionally, using ART with high levels of medication adherence has been shown to substantially reduce the risk of HIV transmission (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022). Based on the Behavioral Risk Factor Surveillance System (BRFSS), the percentage of ever tested for HIV increased from 42.9% in 2011 to 45.9% in 2017. Despite this increase, less than half of US adults have ever been tested for HIV over ten years after CDC's recommendations (Patel et al., 2020). "/> <clinicalRecommendationStatement value="The US Preventive Services Task Force recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened (A Recommendation) (Owens, et al., 2019). Since 2006, the CDC has recommended routine opt-out HIV screening (i.e., patient is notified that testing will be performed unless the patient declines) in healthcare facilities of adolescents and adults 13-64 years of age and HIV diagnostic testing of adolescents and adults with clinical signs or symptoms consistent with HIV infection (Centers for Disease Control and Prevention, 2006). "/> <group id="Group_1"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring"> <valueCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/> <code value="proportion"/> <display value="Proportion"/> </coding> </valueCodeableConcept> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis"> <valueCode value="boolean"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type"> <valueCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-type"/> <code value="process"/> <display value="Process"/> </coding> </valueCodeableConcept> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation"> <valueCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/> <code value="increase"/> <display value="Increased score indicates improvement"/> </coding> </valueCodeableConcept> </extension> <population id="InitialPopulation_1"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="initial-population"/> <display value="Initial Population"/> </coding> </code> <description value="Patients 15 to 65 years of age at the start of the measurement period without an HIV diagnosis prior to the start of the measurement period AND who had at least one outpatient visit during the day of the measurement period "/> <criteria> <language value="text/cql-identifier"/> <expression value="Initial Population"/> </criteria> </population> <population id="Denominator_1"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="denominator"/> <display value="Denominator"/> </coding> </code> <description value="Equals Initial Population "/> <criteria> <language value="text/cql-identifier"/> <expression value="Denominator"/> </criteria> </population> <population id="DenominatorExclusion_1"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="denominator-exclusion"/> <display value="Denominator Exclusion"/> </coding> </code> <description value="Patients diagnosed with HIV prior to the day of the start of the measurement period "/> <criteria> <language value="text/cql-identifier"/> <expression value="Denominator Exclusions"/> </criteria> </population> <population id="Numerator_1"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="numerator"/> <display value="Numerator"/> </coding> </code> <description value="Patients with documentation of an HIV test performed on or after their 15th birthday and before their 66th birthday "/> <criteria> <language value="text/cql-identifier"/> <expression value="Numerator"/> </criteria> </population> <population id="DenominatorException_1"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="denominator-exception"/> <display value="Denominator Exception"/> </coding> </code> <description value="Patients who die on or before the end of the day of the measurement period "/> <criteria> <language value="text/cql-identifier"/> <expression value="Denominator Exceptions"/> </criteria> </population> </group> <supplementalData id="sde-ethnicity"> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Ethnicity "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Ethnicity"/> </criteria> </supplementalData> <supplementalData id="sde-payer"> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Payer "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Payer"/> </criteria> </supplementalData> <supplementalData id="sde-race"> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Race "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Race"/> </criteria> </supplementalData> <supplementalData id="sde-sex"> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Sex "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Sex"/> </criteria> </supplementalData> </Measure>