{
  "resourceType" : "Measure",
  "id" : "CMS50FHIRReceiptofSpecialistReport",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablemeasure",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cql-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/elm-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b style=\"color: maroon\">Exception generating Narrative: unable to parse character reference ' Medicaid Services.\n'' (last text = '\n\n\n\n' at line 408 column 2</b></p></div>"
  },
  "contained" : [{
    "resourceType" : "Library",
    "id" : "effective-data-requirements",
    "extension" : [{
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "248153007",
        "display" : "Male (finding)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "248152002",
        "display" : "Female (finding)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://hl7.org/fhir/CodeSystem/task-code",
        "code" : "fulfill",
        "display" : "Fulfill"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://www.ama-assn.org/go/cpt",
        "code" : "96156",
        "display" : "Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://www.ama-assn.org/go/cpt",
        "code" : "96136",
        "display" : "Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://www.ama-assn.org/go/cpt",
        "code" : "96138",
        "display" : "Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://www.ama-assn.org/go/cpt",
        "code" : "90839",
        "display" : "Psychotherapy for crisis; first 60 minutes"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://www.ama-assn.org/go/cpt",
        "code" : "96112",
        "display" : "Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour"
      }
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Sex"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Sex\":\n  case\n    when Patient.sex() = '248153007' then \"Male (finding)\"\n    when Patient.sex() = '248152002' then \"Female (finding)\"\n    else null\n  end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 0
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS50FHIRReceiptofSpecialistReport"
      },
      {
        "url" : "name",
        "valueString" : "SDE Sex"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 1
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS50FHIRReceiptofSpecialistReport"
      },
      {
        "url" : "name",
        "valueString" : "First Referral during First 10 Months of Measurement Period"
      },
      {
        "url" : "statement",
        "valueString" : "define \"First Referral during First 10 Months of Measurement Period\":\n  First([ServiceRequest: \"Referral\"] ReferralOrder\n      where ReferralOrder.status in { 'active', 'completed' }\n        and ReferralOrder.intent = 'order'\n        and date from ReferralOrder.authoredOn during day of Interval[date from start of \"Measurement Period\", Date(year from start of \"Measurement Period\", 10, 31)]\n      sort by date from authoredOn ascending\n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 2
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS50FHIRReceiptofSpecialistReport"
      },
      {
        "url" : "name",
        "valueString" : "Referring Clinician Receives Consultant Report to Close Referral Loop"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Referring Clinician Receives Consultant Report to Close Referral Loop\":\n  exists ( [Task: USQualityCoreCommon.\"Fulfill\"] ConsultantReportObtained\n      with \"First Referral during First 10 Months of Measurement Period\" FirstReferral\n        // TODO: discuss with vendors .focus vs .basedOn\n        \n        such that ( ConsultantReportObtained.focus.references ( FirstReferral )\n            or ConsultantReportObtained.basedOn.references ( FirstReferral )\n        )\n          and ConsultantReportObtained.executionPeriod ends after FirstReferral.authoredOn\n          and ConsultantReportObtained.executionPeriod ends during day of \"Measurement Period\"\n          and ConsultantReportObtained.status = 'completed'\n          and ConsultantReportObtained.reasonCode in \"Consultant Report\"\n            /*\n            TODO: discuss usage of Composition resource for \"Consultant Report\"\n            NOTE: the following does not currently work due to \"Composition\" missing a profile in QICore\n            and exists(\n              ConsultantReportObtained.output.value OV \n                with ([Composition] ReportComposition where ReportComposition.type in \"Consultant Report\") ConsultantReportComposition \n                  such that (OV as Reference).references(ConsultantReportComposition)\n            )\n            */\n  \n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 3
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS50FHIRReceiptofSpecialistReport"
      },
      {
        "url" : "name",
        "valueString" : "Numerator"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Numerator\":\n  \"Referring Clinician Receives Consultant Report to Close Referral Loop\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 4
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS50FHIRReceiptofSpecialistReport"
      },
      {
        "url" : "name",
        "valueString" : "Has Encounter during Measurement Period"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Encounter during Measurement Period\":\n  exists ( ( [\"Encounter\": \"Office Visit\"]\n      union [\"Encounter\": \"Ophthalmological Services\"]\n      union [\"Encounter\": \"Preventive Care Services Established Office Visit, 18 and Up\"]\n      union [\"Encounter\": \"Preventive Care Services, Initial Office Visit, 0 to 17\"]\n      union [\"Encounter\": \"Preventive Care Services Initial Office Visit, 18 and Up\"]\n      union [\"Encounter\": \"Preventive Care, Established Office Visit, 0 to 17\"] ) ValidEncounter\n      where ValidEncounter.status = 'finished'\n        and ValidEncounter.period during day of \"Measurement Period\"\n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 5
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS50FHIRReceiptofSpecialistReport"
      },
      {
        "url" : "name",
        "valueString" : "Has Intervention during Measurement Period"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Intervention during Measurement Period\":\n  exists ( ( ( [\"Procedure\": \"Behavioral/Neuropsych Assessment\"]\n        union [\"Procedure\": \"Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)\"]\n        union [\"Procedure\": \"Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes\"]\n        union [\"Procedure\": \"Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes\"]\n        union [\"Procedure\": \"Psychotherapy for crisis; first 60 minutes\"]\n        union [\"Procedure\": \"Psych Visit Diagnostic Evaluation\"]\n        union [\"Procedure\": \"Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour\"]\n    ).isProcedurePerformed ( ) ) ValidIntervention\n      where ValidIntervention.performed.toInterval ( ) during day of \"Measurement Period\"\n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 6
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS50FHIRReceiptofSpecialistReport"
      },
      {
        "url" : "name",
        "valueString" : "Initial Population"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Initial Population\":\n  ( \"Has Encounter during Measurement Period\"\n      or \"Has Intervention during Measurement Period\"\n  )\n    and \"First Referral during First 10 Months of Measurement Period\" is not null"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 7
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS50FHIRReceiptofSpecialistReport"
      },
      {
        "url" : "name",
        "valueString" : "Denominator"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Denominator\":\n  \"Initial Population\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 8
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Payer"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Payer\":\n  [USQualityCore.Coverage: type in \"Payer Type\"] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 9
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS50FHIRReceiptofSpecialistReport"
      },
      {
        "url" : "name",
        "valueString" : "SDE Payer"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 10
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Ethnicity"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Ethnicity\":\n  (Patient.ethnicity()) E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 11
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS50FHIRReceiptofSpecialistReport"
      },
      {
        "url" : "name",
        "valueString" : "SDE Ethnicity"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 12
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Race"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Race\":\n  (Patient.race()) R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 13
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS50FHIRReceiptofSpecialistReport"
      },
      {
        "url" : "name",
        "valueString" : "SDE Race"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Race\":\n  SDE.\"SDE Race\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 14
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value string): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 15
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "USCoreCommon"
      },
      {
        "url" : "name",
        "valueString" : "sex"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns the sex element as defined for the USCore patient profile\n*/\ndefine fluent function sex(patient Patient):\n  patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex').value as FHIR.code"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 16
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "ext"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns the single extension (if present) on the given resource with the specified url.\n@comment: This function uses singleton from to ensure that a run-time exception is thrown if there\nis more than one extension on the given resource with the specified url.\n*/\ndefine fluent function ext(domainResource DomainResource, url String):\n  singleton from domainResource.exts(url)"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 17
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "exts"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns any extensions defined on the given resource with the specified url\n*/\ndefine fluent function exts(domainResource DomainResource, url String):\n  domainResource.extension E\n    where E.url = url\n    return E"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 18
      }],
      "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" : 19
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value ServiceRequestStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 20
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value ServiceRequestIntent): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 21
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToDateTime"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToDateTime(value dateTime): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 22
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "references"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns true if the given reference is to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(reference FHIR.Reference, resource FHIR.Resource):\n  resource.id = Last(Split(reference.reference, '/'))"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 23
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "references"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns true if any of the given references are to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(references List<FHIR.Reference>, resource FHIR.Resource):\n  exists (references R where R.references(resource))"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 24
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)\nvalue to a CQL DateTime Interval\n@comment: If the start value of the given period is unspecified, the starting\nboundary of the resulting interval will be open (meaning the start of the interval\nis unknown, as opposed to interpreted as the beginning of time).\n*/\ndefine function ToInterval(period FHIR.Period):\n    if period is null then\n        null\n    else\n        if period.\"start\" is null then\n            Interval(period.\"start\".value, period.\"end\".value]\n        else\n            Interval[period.\"start\".value, period.\"end\".value]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 25
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value TaskStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 26
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToConcept"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 27
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToCode"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 28
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value EncounterStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 29
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isProcedurePerformed"
      },
      {
        "url" : "statement",
        "valueString" : "//Procedure, Performed\ndefine fluent function isProcedurePerformed(Proc List<FHIR.Procedure>):\n  Proc P\n    where P.status ~ 'completed'"
      },
      {
        "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 ProcedureStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 31
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "toInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in FHIR, allowing this function to be used across any resource.\n\nThe input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime.\nIf the input is a Period, the result is a DateTime Interval.\nIf the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.\nIf the input is an instant, the result is a DateTime Interval beginning and ending on that instant.\nIf the input is a string, an error is raised indicating a single interval cannot be computed from a string.\nIf the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,\nand ending immediately prior to when the patient was the given Age plus one year.\nIf the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given\nby the low end of the Range, and ending immediately prior to when the patient was the Age given by the\nhigh end of the Range plus one year.\n\nNOTE: Due to the\ncomplexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used\nwith a Timing or String.\n*/\ndefine fluent function toInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):\n  case\n    when choice is FHIR.dateTime then\n      Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]\n    when choice is FHIR.Period then\n      FHIRHelpers.ToInterval(choice as FHIR.Period)\n    when choice is FHIR.instant then\n      Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]\n    when choice is FHIR.Age then\n      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),\n        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)\n    when choice is FHIR.Range then\n      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),\n        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)\n    when choice is FHIR.Timing then\n      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported')\n    when choice is FHIR.string then\n      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')\n    else\n      null as Interval<DateTime>\n  end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 32
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToDateTime"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToDateTime(value instant): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 33
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToDate"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToDate(value date): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 34
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToQuantity"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) \nvalue to a CQL Quantity\n@comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity\nhas a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`)\nan error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used.\n@seealso: ToCalendarUnit\n*/\ndefine function ToQuantity(quantity FHIR.Quantity):\n    case\n        when quantity is null then null\n        when quantity.value is null then null\n        when quantity.comparator is not null then\n            Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')\n        when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'\n              or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then\n            System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }\n        else\n            Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')\n    end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 35
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToCalendarUnit"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts a UCUM definite duration unit to a CQL calendar duration\nunit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) \ntopic of the CQL specification.\n@comment: Note that for durations above days (or weeks), the conversion is understood to be approximate\n*/\ndefine function ToCalendarUnit(unit System.String):\n    case unit\n        when 'ms' then 'millisecond'\n        when 's' then 'second'\n        when 'min' then 'minute'\n        when 'h' then 'hour'\n        when 'd' then 'day'\n        when 'wk' then 'week'\n        when 'mo' then 'month'\n        when 'a' then 'year'\n        else unit\n    end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 36
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "USCoreCommon"
      },
      {
        "url" : "name",
        "valueString" : "ethnicity"
      },
      {
        "url" : "statement",
        "valueString" : "define fluent function ethnicity(patient Patient):\n  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity')) E\n    return {\n      ombCategory: E.ext('ombCategory').value as FHIR.Coding,\n      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,\n      text: E.ext('text').value as FHIR.string\n    }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 37
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "ext"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns the single extension (if present) on the given element with the specified url.\n@comment: This function uses singleton from to ensure that a run-time exception is thrown if there\nis more than one extension on the given element with the specified url.\n*/\ndefine fluent function ext(element Element, url String):\n  singleton from element.exts(url)"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 38
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "exts"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns any extensions defined on the given element with the specified url.\n*/\ndefine fluent function exts(element Element, url String):\n  element.extension E\n    where E.url = url\n    return E"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 39
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "USCoreCommon"
      },
      {
        "url" : "name",
        "valueString" : "race"
      },
      {
        "url" : "statement",
        "valueString" : "define fluent function race(patient Patient):\n  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-race')) E\n    return {\n      ombCategory: (E.exts('ombCategory')) o return o.value as FHIR.Coding,\n      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,\n      text: E.ext('text').value as FHIR.string\n    }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 40
      }],
      "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" : "USQualityCore model information",
      "resource" : "https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild"
    },
    {
      "type" : "depends-on",
      "display" : "USCore model information",
      "resource" : "http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived"
    },
    {
      "type" : "depends-on",
      "display" : "FHIR model information",
      "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1"
    },
    {
      "type" : "depends-on",
      "display" : "Library SDE",
      "resource" : "https://madie.cms.gov/Library/SupplementalDataElements|6.1.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library FHIRHelpers",
      "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1"
    },
    {
      "type" : "depends-on",
      "display" : "Library USCommon",
      "resource" : "http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot"
    },
    {
      "type" : "depends-on",
      "display" : "Library FHIRCommon",
      "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0"
    },
    {
      "type" : "depends-on",
      "display" : "Library USQualityCoreCommon",
      "resource" : "https://madie.cms.gov/Library/USQualityCoreCommon|0.1.0-cibuild"
    },
    {
      "type" : "depends-on",
      "display" : "Library Status",
      "resource" : "https://madie.cms.gov/Library/Status|2.1.000"
    },
    {
      "type" : "depends-on",
      "display" : "Code system SNOMEDCT",
      "resource" : "http://snomed.info/sct"
    },
    {
      "type" : "depends-on",
      "display" : "Code system TaskCodeSystem",
      "resource" : "http://hl7.org/fhir/CodeSystem/task-code"
    },
    {
      "type" : "depends-on",
      "display" : "Code system CPT",
      "resource" : "http://www.ama-assn.org/go/cpt"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Referral",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1046"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Consultant Report",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.121.12.1006"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Office Visit",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Ophthalmological Services",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Preventive Care Services Established Office Visit, 18 and Up",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Preventive Care Services, Initial Office Visit, 0 to 17",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Preventive Care Services Initial Office Visit, 18 and Up",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Preventive Care, Established Office Visit, 0 to 17",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Behavioral/Neuropsych Assessment",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1023"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Psych Visit Diagnostic Evaluation",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Payer Type",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
    }],
    "parameter" : [{
      "name" : "Measurement Period",
      "use" : "in",
      "min" : 0,
      "max" : "1",
      "type" : "Period"
    },
    {
      "name" : "SDE Sex",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "type" : "Coding"
    },
    {
      "name" : "Numerator",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "type" : "boolean"
    },
    {
      "name" : "Denominator",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "type" : "boolean"
    },
    {
      "name" : "SDE Payer",
      "use" : "out",
      "min" : 0,
      "max" : "*",
      "type" : "Resource"
    },
    {
      "name" : "Initial Population",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "type" : "boolean"
    },
    {
      "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://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient"],
      "mustSupport" : ["ombCategory",
      "detailed",
      "text"]
    },
    {
      "type" : "ServiceRequest",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/ServiceRequest"],
      "mustSupport" : ["code",
      "status",
      "intent",
      "authoredOn"],
      "codeFilter" : [{
        "path" : "code",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1046"
      },
      {
        "path" : "intent",
        "code" : [{
          "code" : "order"
        }]
      }]
    },
    {
      "type" : "Resource",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Resource"],
      "mustSupport" : ["id"]
    },
    {
      "type" : "Task",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Task"],
      "mustSupport" : ["code",
      "focus",
      "basedOn",
      "executionPeriod",
      "status",
      "reasonCode"],
      "codeFilter" : [{
        "path" : "code",
        "code" : [{
          "system" : "http://hl7.org/fhir/CodeSystem/task-code",
          "code" : "fulfill",
          "display" : "Fulfill"
        }]
      },
      {
        "path" : "status",
        "code" : [{
          "code" : "completed"
        }]
      },
      {
        "path" : "reasonCode",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.121.12.1006"
      }],
      "dateFilter" : [{
        "path" : "executionPeriod",
        "valuePeriod" : {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
            "valueExpression" : {
              "language" : "text/cql-identifier",
              "expression" : "Measurement Period"
            }
          }]
        }
      }]
    },
    {
      "type" : "Encounter",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"],
      "mustSupport" : ["type",
      "status",
      "period"],
      "codeFilter" : [{
        "path" : "type",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
      }]
    },
    {
      "type" : "Encounter",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"],
      "mustSupport" : ["type",
      "status",
      "period"],
      "codeFilter" : [{
        "path" : "type",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285"
      }]
    },
    {
      "type" : "Encounter",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"],
      "mustSupport" : ["type",
      "status",
      "period"],
      "codeFilter" : [{
        "path" : "type",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"
      }]
    },
    {
      "type" : "Encounter",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"],
      "mustSupport" : ["type",
      "status",
      "period"],
      "codeFilter" : [{
        "path" : "type",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022"
      }]
    },
    {
      "type" : "Encounter",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"],
      "mustSupport" : ["type",
      "status",
      "period"],
      "codeFilter" : [{
        "path" : "type",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"
      }]
    },
    {
      "type" : "Encounter",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"],
      "mustSupport" : ["type",
      "status",
      "period"],
      "codeFilter" : [{
        "path" : "type",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024"
      }]
    },
    {
      "type" : "Patient",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Patient"],
      "mustSupport" : ["birthDate"]
    },
    {
      "type" : "Procedure",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"],
      "mustSupport" : ["code",
      "status",
      "performed"],
      "codeFilter" : [{
        "path" : "code",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1023"
      }]
    },
    {
      "type" : "Procedure",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"],
      "mustSupport" : ["code",
      "status",
      "performed"],
      "codeFilter" : [{
        "path" : "code",
        "code" : [{
          "system" : "http://www.ama-assn.org/go/cpt",
          "code" : "96156",
          "display" : "Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)"
        }]
      }]
    },
    {
      "type" : "Procedure",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"],
      "mustSupport" : ["code",
      "status",
      "performed"],
      "codeFilter" : [{
        "path" : "code",
        "code" : [{
          "system" : "http://www.ama-assn.org/go/cpt",
          "code" : "96136",
          "display" : "Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes"
        }]
      }]
    },
    {
      "type" : "Procedure",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"],
      "mustSupport" : ["code",
      "status",
      "performed"],
      "codeFilter" : [{
        "path" : "code",
        "code" : [{
          "system" : "http://www.ama-assn.org/go/cpt",
          "code" : "96138",
          "display" : "Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes"
        }]
      }]
    },
    {
      "type" : "Procedure",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"],
      "mustSupport" : ["code",
      "status",
      "performed"],
      "codeFilter" : [{
        "path" : "code",
        "code" : [{
          "system" : "http://www.ama-assn.org/go/cpt",
          "code" : "90839",
          "display" : "Psychotherapy for crisis; first 60 minutes"
        }]
      }]
    },
    {
      "type" : "Procedure",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"],
      "mustSupport" : ["code",
      "status",
      "performed"],
      "codeFilter" : [{
        "path" : "code",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492"
      }]
    },
    {
      "type" : "Procedure",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"],
      "mustSupport" : ["code",
      "status",
      "performed"],
      "codeFilter" : [{
        "path" : "code",
        "code" : [{
          "system" : "http://www.ama-assn.org/go/cpt",
          "code" : "96112",
          "display" : "Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour"
        }]
      }]
    },
    {
      "type" : "Coverage",
      "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-coverage"],
      "mustSupport" : ["type",
      "period"],
      "codeFilter" : [{
        "path" : "type",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
      }]
    }]
  }],
  "extension" : [{
    "id" : "supplementalDataGuidance",
    "extension" : [{
      "url" : "guidance",
      "valueString" : "For every patient evaluated by this measure also identify payer, race, ethnicity and 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" : "Referral"
    },
    {
      "url" : "definition",
      "valueMarkdown" : "A request from one clinician to another clinician for evaluation, treatment, or co-management of a patient's condition. This term encompasses referral and consultation as defined by Centers for Medicare \\& Medicaid Services.\n"
    }],
    "url" : "http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm"
  },
  {
    "extension" : [{
      "url" : "term",
      "valueString" : "Report"
    },
    {
      "url" : "definition",
      "valueMarkdown" : "A written document prepared by the eligible clinician (and staff) to whom the patient was referred and that accounts for his or her findings, provides summary of care information about findings, diagnostics, assessments and/or plans of care, and is provided to the referring eligible clinician.\n"
    }],
    "url" : "http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm"
  },
  {
    "url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem",
    "valueReference" : {
      "reference" : "Device/cqf-tooling"
    }
  },
  {
    "url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
    "valueCanonical" : "#effective-data-requirements"
  }],
  "url" : "https://madie.cms.gov/Measure/CMS50FHIRReceiptofSpecialistReport",
  "identifier" : [{
    "use" : "usual",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
        "code" : "short-name",
        "display" : "Short Name"
      }]
    },
    "system" : "https://madie.cms.gov/measure/shortName",
    "value" : "CMS50FHIR"
  },
  {
    "use" : "official",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
        "code" : "version-independent",
        "display" : "Version Independent"
      }]
    },
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:uuid:75691bbe-451e-4e3a-9a95-6361f7b45196"
  },
  {
    "use" : "official",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
        "code" : "version-specific",
        "display" : "Version Specific"
      }]
    },
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:uuid:00ad5281-ab7f-4e65-842f-b296dd094771"
  },
  {
    "use" : "official",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
        "code" : "publisher",
        "display" : "Publisher"
      }]
    },
    "system" : "https://madie.cms.gov/measure/cmsId",
    "value" : "50FHIR",
    "assigner" : {
      "display" : "CMS"
    }
  }],
  "version" : "1.0.000",
  "name" : "CMS50FHIRReceiptofSpecialistReport",
  "title" : "Closing the Referral Loop: Receipt of Specialist ReportFHIR\n",
  "status" : "active",
  "experimental" : false,
  "date" : "2026-01-16T18:18:13+00:00",
  "publisher" : "Centers for Medicare &amp; Medicaid Services (CMS)",
  "contact" : [{
    "telecom" : [{
      "system" : "url",
      "value" : "https://www.cms.gov/"
    }]
  }],
  "description" : "Percentage of patients with referrals, regardless of age, for which the referring clinician receives a report from the clinician to whom the patient was referred\n",
  "usage" : "The clinician who refers the patient to another clinician is the clinician who should be held accountable for the performance of this measure. Only the first referral made between January 1 -- October 31 of the measurement period will be considered for this measure to allow adequate time for the referring clinician to collect the consult report by the end of the measurement period. If there are multiple referrals for a patient during the measurement period, use the first referral. The clinician to whom the patient was referred is responsible for sending the consultant report that will fulfill the communication. Note: this is not the same clinician who would report on the measure. The consultant report that will successfully close the referral loop should be related to the first referral for a patient during the measurement period. If there are multiple consultant reports received by the referring clinician which pertain to a particular referral, use the first consultant report to satisfy the measure. Eligible clinicians reporting on this measure should note that all data for the measurement period is to be submitted by the deadline established by CMS. Therefore, eligible clinicians who refer patients towards the end of the measurement period (i.e., October), should request that clinicians to whom they referred their patients share their consult reports as soon as possible in order for those patients to be counted in the measure numerator during the measurement period. When clinicians to whom patients are referred communicate the consult report as soon as possible with the referring clinician, it ensures that the communication loop is closed in a timely manner and that the data are included in the submission to CMS. A procedural report received from a specialist for an exam or procedure conducted (e.g., diabetic eye exam, colonoscopy, etc.) can satisfy the numerator requirement and successfully close the referral loop. A separate consultant note or consultant report is not required to close the referral loop in these circumstances. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS50v14. 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 6.0.0 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).\n",
  "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 Organisation.\n",
  "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" : "Greenwood-Lee, J., Jewett, L., Woodhouse, L., \\& Marshall, D. A. (2018). A categorisation of problems and solutions to improve patient referrals from primary to specialty care. BMC health services research, 18(1), 986. https://doi.org/10.1186/s12913-018-3745-y\n"
  },
  {
    "type" : "citation",
    "citation" : "Institute for Healthcare Improvement / National Patient Safety Foundation. (2017). Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era. https://www.ihi.org/resources/Pages/Publications/Closing-the-Loop-A-Guide-to-Safer-Ambulatory-Referrals.aspx\n"
  },
  {
    "type" : "citation",
    "citation" : "Odisho, A. Y., Lui, H., Yerramsetty, R., Bautista, F., Gleason, N., Martin, E., Young, J. J., Blum, M., \\& Neinstein, A. B. (2020). Design and development of referrals automation, a SMART on FHIR solution to improve patient access to specialty care. JAMIA open, 3(3), 405--412. https://doi.org/10.1093/jamiaopen/ooaa036\n"
  },
  {
    "type" : "citation",
    "citation" : "Patel, M. P., Schettini, P., O'Leary, C. P., Bosworth, H. B., Anderson, J. B., \\& Shah, K. P. (2018). Closing the Referral Loop: an Analysis of Primary Care Referrals to Specialists in a Large Health System. Journal of general internal medicine, 33(5), 715--721. https://doi.org/10.1007/s11606-018-4392-z\n"
  },
  {
    "type" : "citation",
    "citation" : "Ramelson, H., Nederlof, A., Karmiy, S., Neri, P., Kiernan, D., Krishnamurthy, R., Allen, A., \\& Bates, D. W. (2018). Closing the loop with an enhanced referral management system. Journal of the American Medical Informatics Association: JAMIA, 25(6), 715--721. https://doi.org/10.1093/jamia/ocy004\n"
  }],
  "library" : ["https://madie.cms.gov/Library/CMS50FHIRReceiptofSpecialistReport"],
  "disclaimer" : "This performance Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or \\[R\\] and unregistered trademarks are indicated by (TM) or \\[TM\\].\n",
  "rationale" : "Problems in the outpatient referral and consultation process have been documented, including inadequate care pathways between specialty and primary care. Studies suggest that both specialists and primary care providers (PCPs) are not satisfied with current processes (Institute for Healthcare Improvement / National Patient Safety Foundation, 2017; Greenwood-Lee et. al, 2018). Breakdowns in referral communication leads to worse health outcomes, increased cost, and appointment delays (Patel et. al, 2018; Odisho et. al, 2020). A 2018 analysis of primary care referrals to specialists found that of the 103,737 referral scheduling attempts analyzed, only 36,072 (34.8%) resulted in documented complete appointments, defined by the specialty clinician providing report to the PCP after the referral visit (Patel et. al, 2018). Technological and process-based updates can improve the referral loop process and increase rates of closing the referral loop. Ramelson et. al (2018) enhanced an EHR's Referral Manager module to meet the Controlled Risk Insurance Company's best practice steps and the requirements of both the CMS EHR Incentive Program and the National Committee for Quality Assurance Patient-Centered Medical Home program. Following the updates, 76.8% of referrals were completed and all defined referral process steps were easier to accomplish. Odisho et. al (2020) developed a referrals automation software to simplify the fax to referral process. Feedback from key stakeholder interviews noted that the software enhanced the referrals process by further streamlining and organizing the patient referral process. The Institute for Healthcare Improvement and the National Patient Safety Foundation (2017) reviewed the referrals process in the ambulatory care setting and found that organizational leaders, EHR vendors, regulatory agencies, clinicians, and patients all play a role in creating a referrals system that is effective, safe, convenient, and patient-centered.\n",
  "clinicalRecommendationStatement" : "None\n",
  "group" : [{
    "id" : "Group_1",
    "extension" : [{
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
          "code" : "proportion",
          "display" : "Proportion"
        }]
      }
    },
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
      "valueCode" : "boolean"
    },
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-type",
          "code" : "process",
          "display" : "Process"
        }]
      }
    },
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
      "valueString" : "None\n"
    },
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
          "code" : "increase",
          "display" : "Increased score indicates improvement"
        }]
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-improvementNotationGuidance",
      "valueMarkdown" : "Higher score indicates better quality\n"
    }],
    "description" : "Percentage of patients with referrals, regardless of age, for which the referring clinician receives a report from the clinician to whom the patient was referred\n",
    "population" : [{
      "id" : "InitialPopulation_1",
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "initial-population",
          "display" : "Initial Population"
        }]
      },
      "description" : "Number of patients, regardless of age, who had an encounter during the measurement period and were referred by one clinician to another clinician on or before October 31\n",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Initial Population"
      }
    },
    {
      "id" : "Denominator_1",
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "denominator",
          "display" : "Denominator"
        }]
      },
      "description" : "Equals Initial Population\n",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Denominator"
      }
    },
    {
      "id" : "Numerator_1",
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "numerator",
          "display" : "Numerator"
        }]
      },
      "description" : "Number of patients with a referral on or before October 31, for which the referring clinician received a report from the first clinician to whom the patient was referred\n",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Numerator"
      }
    }]
  }],
  "supplementalData" : [{
    "id" : "sde-ethnicity",
    "usage" : [{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    }],
    "description" : "SDE Ethnicity\n",
    "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\n",
    "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\n",
    "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\n",
    "criteria" : {
      "language" : "text/cql-identifier",
      "expression" : "SDE Sex"
    }
  }]
}