dQM QICore Content Implementation Guide
2025.0.0 - CI Build

dQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2025.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/dqm-content-qicore-2025/ and changes regularly. See the Directory of published versions

Library: CMS1157FHIRHIVRetention

Official URL: https://madie.cms.gov/Library/CMS1157FHIRHIVRetention Version: 1.0.000
Active as of 2025-08-22 Responsible: Health Resources & Services Administration Computable Name: CMS1157FHIRHIVRetention
Other Identifiers: https://madie.cms.gov/login#CMS1157FHIRHIVRetention (use: official, )

CMS1157FHIRHIVRetention

Metadata
Title CMS1157FHIRHIVRetention
Version 1.0.000
Identifier CMS1157FHIRHIVRetention
Steward (Publisher) Health Resources & Services Administration
Description

CMS1157FHIRHIVRetention
Type http://terminology.hl7.org/CodeSystem/library-type#logic-library
Data Requirement Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: Office Visit
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: Outpatient Consultation
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: Annual Wellness Visit
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: Face to Face Interaction
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: Home Healthcare Services
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: Preventive Care Services Established Office Visit, 18 and Up
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: Preventive Care Services Initial Office Visit, 18 and Up
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: Preventive Care Services, Initial Office Visit, 0 to 17
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: Preventive Care, Established Office Visit, 0 to 17
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: Telephone Visits
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: Preventive Care Services Other
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: HIV
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: HIV
Data Requirement Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab
Must Support Elements: code, status, status.value, effective
Code Filter(s):
Path: code
ValueSet: HIV Viral Load Tests
Parameters
Name Use Card. Type Documentation
Measurement Period In 0..1 Period
Patient Out 0..1 Resource
Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period Out 0..1 boolean
Has Qualifying Encounter During First 240 Days of Measurement Period Out 0..1 boolean
Initial Population Out 0..1 boolean
Denominator Out 0..1 boolean
Encounter During Measurement Period With HIV Out 0..* Resource
Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart Out 0..1 boolean
Has Two Encounters With HIV At Least 90 Days Apart Out 0..1 boolean
Numerator Out 0..1 boolean
SDE Ethnicity Out 0..1 Resource
SDE Payer Out 0..* Resource
SDE Race Out 0..1 Resource
SDE Sex Out 0..1 Coding
Library Content
CQL Content 
library CMS1157FHIRHIVRetention version '1.0.000'

using QICore version '6.0.0'

include FHIRHelpers version '4.4.000' called FHIRHelpers
include SupplementalDataElements version '5.1.000' called SDE
include QICoreCommon version '4.0.000' called QICoreCommon

valueset "Annual Wellness Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240'
valueset "Face-to-Face Interaction": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.375'
valueset "HIV": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003'
valueset "HIV Viral Load Tests": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.377'
valueset "Home Healthcare Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016'
valueset "Office Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001'
valueset "Outpatient Consultation": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008'
valueset "Preventive Care Services Established Office Visit, 18 and Up": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025'
valueset "Preventive Care Services Initial Office Visit, 18 and Up": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023'
valueset "Preventive Care Services, Initial Office Visit, 0 to 17": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022'
valueset "Preventive Care, Established Office Visit, 0 to 17": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024'
valueset "Telephone Visits": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080'
valueset "Preventive Care Services Other": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.11.1150'

parameter "Measurement Period" Interval<DateTime>
  default Interval[@2026-01-01T00:00:00.000Z, @2027-01-01T00:00:00.000Z)

context Patient

define "Initial Population":
  "Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period"
    and "Has Qualifying Encounter During First 240 Days of Measurement Period"

define "Denominator":
  "Initial Population"

define "Numerator":
  "Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart"
    or "Has Two Encounters With HIV At Least 90 Days Apart"

define "Encounter During Measurement Period With HIV":
  ( ( ["Encounter": "Office Visit"]
      union ["Encounter": "Outpatient Consultation"]
      union ["Encounter": "Annual Wellness Visit"]
      union ["Encounter": "Face-to-Face Interaction"]
      union ["Encounter": "Home Healthcare Services"]
      union ["Encounter": "Preventive Care Services Established Office Visit, 18 and Up"]
      union ["Encounter": "Preventive Care Services Initial Office Visit, 18 and Up"]
      union ["Encounter": "Preventive Care Services, Initial Office Visit, 0 to 17"]
      union ["Encounter": "Preventive Care, Established Office Visit, 0 to 17"]
      union ["Encounter": "Telephone Visits"]
      union ["Encounter": "Preventive Care Services Other"] ) ValidEncounter
      with ( ["ConditionProblemsHealthConcerns": "HIV"]
        union ["ConditionEncounterDiagnosis": "HIV"] ) HIVDiagnosis
        such that ValidEncounter.period during day of "Measurement Period"
          and ValidEncounter.status = 'finished'
          and HIVDiagnosis.prevalenceInterval ( ) starts on or before day of start of ValidEncounter.period
          and HIVDiagnosis.isVerified ( )
  )

define "Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period":
  exists ( ( ["ConditionProblemsHealthConcerns": "HIV"]
      union ["ConditionEncounterDiagnosis": "HIV"] ) HIVDx
      where HIVDx.prevalenceInterval ( ) starts on or before day of ( start of "Measurement Period" + 240 days )
        and HIVDx.isVerified ( )
  )

define "Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart":
  exists ( "Encounter During Measurement Period With HIV" ) EncounterWithHIV
    with ["LaboratoryResultObservation": "HIV Viral Load Tests"] ViralLoadTest
      such that ViralLoadTest.status in { 'final', 'amended', 'corrected' }
        and ViralLoadTest.effective.toInterval ( ) during day of "Measurement Period"
        and ( ( ViralLoadTest.effective.toInterval ( ) starts 90 days or more after day of end of EncounterWithHIV.period )
            or ( EncounterWithHIV.period starts 90 days or more after day of end of ViralLoadTest.effective.toInterval ( ) )
        )

define "Has Qualifying Encounter During First 240 Days of Measurement Period":
  exists ( ["Encounter": "Office Visit"]
    union ["Encounter": "Outpatient Consultation"]
    union ["Encounter": "Annual Wellness Visit"]
    union ["Encounter": "Face-to-Face Interaction"]
    union ["Encounter": "Home Healthcare Services"]
    union ["Encounter": "Preventive Care Services Established Office Visit, 18 and Up"]
    union ["Encounter": "Preventive Care Services Initial Office Visit, 18 and Up"]
    union ["Encounter": "Preventive Care Services, Initial Office Visit, 0 to 17"]
    union ["Encounter": "Preventive Care, Established Office Visit, 0 to 17"]
    union ["Encounter": "Telephone Visits"]
    union ["Encounter": "Preventive Care Services Other"] ) QualifyingEncounter
    where QualifyingEncounter.period during day of Interval[start of "Measurement Period", start of "Measurement Period" + 240 days]

define "Has Two Encounters With HIV At Least 90 Days Apart":
  exists "Encounter During Measurement Period With HIV" EncounterWithHIV
    with "Encounter During Measurement Period With HIV" AnotherEncounterWithHIV
      such that EncounterWithHIV !~ AnotherEncounterWithHIV
        and AnotherEncounterWithHIV.period starts 90 days or more after day of end of EncounterWithHIV.period

define fluent function isVerified(condition Choice<QICore.ConditionProblemsHealthConcerns, QICore.ConditionEncounterDiagnosis>):
  condition.verificationStatus is not null implies ( condition.verificationStatus ~ QICoreCommon."confirmed"
      or condition.verificationStatus ~ QICoreCommon."unconfirmed"
      or condition.verificationStatus ~ QICoreCommon."provisional"
      or condition.verificationStatus ~ QICoreCommon."differential"
  )

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

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

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

define "SDE Sex":
  SDE."SDE Sex"
ELM XML Content 
Encoded data
ELM JSON Content 
Encoded data
Citations and References
Dependency Description: Library FHIRHelpers
Resource: FHIRHelpers version: 4.4.000
Canonical URL: https://madie.cms.gov/Library/FHIRHelpers|4.4.000
Dependency Description: Library SDE
Resource: SupplementalDataElements version: 5.1.000
Canonical URL: https://madie.cms.gov/Library/SupplementalDataElements|5.1.000
Dependency Description: Library QICoreCommon
Resource: QICoreCommon version: 4.0.000
Canonical URL: https://madie.cms.gov/Library/QICoreCommon|4.0.000
Dependency Description: Value set Annual Wellness Visit
Resource: Annual Wellness Visit
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240
Dependency Description: Value set Face-to-Face Interaction
Resource: Face to Face Interaction
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.375
Dependency 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
Dependency Description: Value set HIV Viral Load Tests
Resource: HIV Viral Load Tests
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.377
Dependency Description: Value set Home Healthcare Services
Resource: Home Healthcare Services
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
Dependency 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
Dependency Description: Value set Outpatient Consultation
Resource: Outpatient Consultation
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008
Dependency 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
Dependency 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
Dependency 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
Dependency 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
Dependency Description: Value set Telephone Visits
Resource: Telephone Visits
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080
Dependency Description: Value set Preventive Care Services Other
Resource: Preventive Care Services Other
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.11.1150
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