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

: HIV Annual Retention in CareFHIR - XML Representation

Active as of 2025-08-22

Raw xml | Download


<Measure xmlns="http://hl7.org/fhir">
  <id value="CMS1157FHIRHIVRetention"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablemeasure"/>
    <profile
             value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
    <profile
             value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"/>
    <profile
             value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"/>
    <profile
             value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cql-measure-cqfm"/>
    <profile
             value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/elm-measure-cqfm"/>
    <profile
             value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml" class="col-12">
  <table class="narrative-table">
    <tbody>
<tr>


<th colspan="2" scope="row" class="row-header">Metadata</th>


</tr>

<tr>


<th scope="row" class="row-header">Title</th>


<td class="content-container">HIV Annual Retention in CareFHIR</td>
</tr>



<tr>


<th scope="row" class="row-header">Version</th>


<td class="content-container">1.0.000</td>
</tr>


  
<tr>


<th scope="row" class="row-header">Short Name</th>


<td class="content-container">CMS1157FHIR</td>
</tr>



  
<tr>


<th scope="row" class="row-header">GUID (Version Independent)</th>


<td class="content-container">urn:uuid:03878bb8-1209-4f3f-91f6-52b655092251</td>
</tr>



  
<tr>


<th scope="row" class="row-header">GUID (Version Specific)</th>


<td class="content-container">urn:uuid:36e79353-69dd-4ca6-8d94-49fca9c67ca2</td>
</tr>



  
    
    
<tr>


<th scope="row" class="row-header">CMS Identifier</th>


<td class="content-container">1157FHIR</td>
</tr>

  




  
    
    
<tr>


<th scope="row" class="row-header">Effective Period</th>


<td class="content-container">2026-01-01 through 2026-12-31</td>
</tr>

  















<tr>


<th scope="row" class="row-header">Steward (Publisher)</th>


<td class="content-container">Health Resources &amp; Services Administration</td>
</tr>






<tr>


<th scope="row" class="row-header">Developer</th>


<td class="content-container">Health Resources &amp; Services Administration</td>
</tr>






<tr>


<th scope="row" class="row-header">Description</th>


<td class="content-container"><p>Percentage of patients, regardless of age, with a diagnosis of Human Immunodeficiency Virus (HIV) during the first 240 days of the measurement period or before the measurement period who had at least two eligible encounters or at least one eligible encounter and one HIV viral load test that were at least 90 days apart within the measurement period</p></td>
</tr>



<tr>


<th scope="row" class="row-header">Copyright</th>


<td class="content-container"><p>This measure was developed by the Health Resources and Services Administration of the U.S. Department for Health and Human Services. It is in the public domain.</p>
<p>Citation of HRSA as the source of the original measure is appreciated. Any modified versions may not be represented as approved, endorsed, or authorized by HRSA or HHS. 42 U.S.C. Section 1320b-10. Users of modified versions should clearly explain how they deviate from HRSA's original measure.</p>
<p>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.</p>
<p>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. ICD-10 is copyright 2024 World Health Organization. All Rights Reserved.</p>
<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p></td>
</tr>


<tr>


<th scope="row" class="row-header">Disclaimer</th>


<td class="content-container"><p>These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.</p>
<p>THE MEASURES AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.</p>
<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p></td>
</tr>











<tr>


<th scope="row" class="row-header">Rationale</th>


<td class="content-container"><p>The HIV &quot;continuum of care&quot; is the process of HIV testing, linkage to HIV care, initiation of antiretroviral therapy (ART), adherence to treatment, retention in care, and virologic suppression (Gardner et al 2011). Poor retention in care is associated with lower rates of ART use (Giordano et al 2003), delayed viral suppression (Crawford et al 2014), and increased risk of mortality (Giordano et al., 2007; Mugavero et al., 2009). This measure will help providers direct their attention and quality improvement efforts towards improving retention in care.</p></td>
</tr>


<tr>


<th scope="row" class="row-header">Clinical Recommendation Statement</th>


<td class="content-container"><p>&quot;Retention in care should be routinely monitored. There are various ways to measure retention, including measures based on attended visits over a defined period of time (constancy measures) and measures based on missed visits. Both approaches are valid and independently predict survival. Missed visits and a prolonged time since the last visit are relatively easy to measure and should trigger efforts to retain or re-engage a person in care. Constancy measures (e.g., at least two visits that are at least 90 days apart over 1 year or at least one visit every 6 months over the last 2 years) can be used as clinic quality assurance measures&quot; (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. L-4).</p>
<p>&quot;Poor retention in HIV care is associated with greater risk of death. Poor retention is more common in people who use substances, have serious mental health problems, have unmet socioeconomic needs (e.g., housing, food, transportation), lack financial resources or health insurance, have schedules that complicate adherence, have been recently incarcerated, or face stigma. At the provider and health system level, low trust in providers and a poor patient-provider relationship have been associated with lower retention, as has lower satisfaction with the clinic experience. Availability of appointments and timeliness of appointments (i.e., long delay from the request for an appointment to the appointment's date) and scheduling convenience are also factors&quot; (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. L-3).</p>
<p>&quot;Recommendation 2: Systematic monitoring of retention in HIV care is recommended for all patients (II A): Retention in care is associated with improved individual health outcomes, including HIV biomarker and clinical variables, and may reduce community-level viral burden, with implications for secondary prevention. Although monitoring retention is routinely recommended, specific details, such as retention measures to be used and desired visit frequency, vary among jurisdictions and programs and should be in harmony with national and international guidelines. Many retention measures (for example, visit adherence, gaps in care, and visits per interval of time) and data sources (for example, surveillance, medical records, and administrative databases) have been used and may be applied in accordance with local resources and standards of care. As with monitoring of linkage, integration of data sources may enhance monitoring of retention&quot; (Thompson et al., 2012, p. 4).</p></td>
</tr>




<tr>
  
  
  
  

<th scope="row" class="row-header">Citation</th>


  
  
  <td class="content-container">
    
    
    
    <p>Crawford, T. N., Sanderson, W. T., &amp; Thornton, A. (2014). Impact of Poor Retention in HIV Medical Care on Time to Viral Load Suppression. Journal of the International Association of Providers of AIDS Care (JIAPAC), 13(3), 242–249. https://doi.org/10.1177/2325957413491431.</p>
    
    
    
    
    
  </td>
</tr>

<tr>
  
  
  
  

<th scope="row" class="row-header">Citation</th>


  
  
  <td class="content-container">
    
    
    
    <p>Gardner, E. M., McLees, M. P., Steiner, J. F., Del Rio, C., &amp; Burman, W. J. (2011). The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 52(6), 793–800. https://doi.org/10.1093/cid/ciq243.</p>
    
    
    
    
    
  </td>
</tr>

<tr>
  
  
  
  

<th scope="row" class="row-header">Citation</th>


  
  
  <td class="content-container">
    
    
    
    <p>Giordano, T. P., Gifford, A. L., White, A. C., Suarez-Almazor, M. E., Rabeneck, L., Hartman, C., Backus, L. I., Mole, L. A., &amp; Morgan, R. O. (2007). Retention in care: A challenge to survival with HIV infection. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 44(11), 1493-1499. https://doi.org/10.1086/516778.</p>
    
    
    
    
    
  </td>
</tr>

<tr>
  
  
  
  

<th scope="row" class="row-header">Citation</th>


  
  
  <td class="content-container">
    
    
    
    <p>Giordano, T. P., White, A. C., Sajja, P., Graviss, E. A., Arduino, R. C., Adu-Oppong, A., Lahart, C. J., &amp; Visnegarwala, F. (2003). Factors associated with the use of highly active antiretroviral therapy in patients newly entering care in an urban clinic. Journal of Acquired Immune Deficiency Syndromes (JAIDS), 32(4), 399-405. https://doi.org/10.1097/00126334-200304010-00009</p>
    
    
    
    
    
  </td>
</tr>

<tr>
  
  
  
  

<th scope="row" class="row-header">Citation</th>


  
  
  <td class="content-container">
    
    
    
    <p>Mugavero, M. J., Lin, H.-Y., Willig, J. H., Westfall, A. O., Ulett, K. B., Routman, J. S., Abroms, S., Raper, J. L., Saag, M. S., &amp; Allison, J. J. (2009). Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 48(2), 248–256. https://doi.org/10.1086/595705</p>
    
    
    
    
    
  </td>
</tr>

<tr>
  
  
  
  

<th scope="row" class="row-header">Citation</th>


  
  
  <td class="content-container">
    
    
    
    <p>Panel on Antiretroviral Guidelines for Adults and Adolescents. &quot;Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV.&quot; Washington, DC: U.S. Department of Health and Human Services, 2022. Available at https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf Updated September 21, 2022. Accessed December 15, 2022.</p>
    
    
    
    
    
  </td>
</tr>

<tr>
  
  
  
  

<th scope="row" class="row-header">Citation</th>


  
  
  <td class="content-container">
    
    
    
    <p>Thompson, M. A., Mugavero, M. J., Amico, K. R., Cargill, V. A., Chang, L. W., Gross, R., Orrell, C., Altice, F. L., Bangsberg, D. R., Bartlett, J. G., Beckwith, C. G., Dowshen, N., Gordon, C. M., Horn, T., Kumar, P., Scott, J. D., Stirratt, M. J., Remien, R. H., Simoni, J. M., &amp; Nachega, J. B. (2012). Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care panel. Annals of internal medicine, 156(11), 817-294. https://doi.org/10.7326/0003-4819-156-11-201206050-00419</p>
    
    
    
    
    
  </td>
</tr>






  
  
<tr>


<th scope="row" class="row-header">Definition</th>


<td class="content-container">Month: <p>To maintain consistency from year to year, this measure defines one month as equal to 30 days, three months as equal to 90 days and eight months as equal to 240 days</p></td>
</tr>



<tr>


<th scope="row" class="row-header">Guidance (Usage)</th>


<td class="content-container"><p>A patient would be included in the measure numerator if they have either two eligible encounters or one eligible encounter and one viral load test at least 90 days apart from each other. The encounter or encounters that cause a patient to be included in the numerator do not need to include the encounter that caused the patient to be included in the denominator.</p>
<p>Only patients with an eligible encounter in the first eight months are included in this measure to allow for sufficient time to complete a second eligible encounter or viral load laboratory within the 12-month measurement period and at least 90 days after the initial encounter.</p>
<p>This eCQM is a patient-based measure. This measure is to be submitted a minimum of once per measurement period for patients with a diagnosis of HIV during the first eight months of the measurement period.</p>
<p>This FHIR-based measure has been derived from the QDM-based measure CMS1157v2. 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).</p></td>
</tr>



  
    
    <tr>


<th colspan="2" scope="row" class="row-header">Measure Group (Rate) (ID: Group_1)</th>


</tr>
  
  
  
  
<tr>


<th scope="row" class="row-header">Basis</th>


<td class="content-container">boolean</td>
</tr>



  
<tr>


<th scope="row" class="row-header">Scoring</th>


<td class="content-container">[http://terminology.hl7.org/CodeSystem/measure-scoring#proportion: 'Proportion']</td>
</tr>







  
<tr>


<th scope="row" class="row-header">Type</th>


<td class="content-container">[http://terminology.hl7.org/CodeSystem/measure-type#process: 'Process']</td>
</tr>





  
<tr>


<th scope="row" class="row-header">Improvement Notation</th>


<td class="content-container">[http://terminology.hl7.org/CodeSystem/measure-improvement-notation#increase: 'Increased score indicates improvement']</td>
</tr>


  
  
    <tr>
      
        

<th scope="row" class="row-header">Initial Population</th>


      
      <td class="content-container">
        
        <em>ID</em>: InitialPopulation_1
        <br/>
        
        
          <em>Description</em>:
          <p style="white-space: pre-line" class="tab-one"><p>All patients, regardless of age, with a diagnosis of HIV during the first 240 days of the measurement period or before the measurement period who had at least one eligible encounter during the first 240 days of the measurement period</p></p>
        
        
          
            
            <em>Logic Definition</em>: <a href="#primary-cms1157fhirhivretention-initial-population">Initial Population</a> 
          
        
      </td>
    </tr>
  

  
    <tr>
      
        

<th scope="row" class="row-header">Denominator</th>


      
      <td class="content-container">
        
        <em>ID</em>: Denominator_1
        <br/>
        
        
          <em>Description</em>:
          <p style="white-space: pre-line" class="tab-one"><p>Equals Initial Population</p></p>
        
        
          
            
            <em>Logic Definition</em>: <a href="#primary-cms1157fhirhivretention-denominator">Denominator</a> 
          
        
      </td>
    </tr>
  

  
    <tr>
      
        

<th scope="row" class="row-header">Numerator</th>


      
      <td class="content-container">
        
        <em>ID</em>: Numerator_1
        <br/>
        
        
          <em>Description</em>:
          <p style="white-space: pre-line" class="tab-one"><p>Number of patients who had at least one eligible encounter and one HIV viral load test at least 90 days apart during the measurement period, or who had at least two eligible encounters at least 90 days apart during the measurement period</p></p>
        
        
          
            
            <em>Logic Definition</em>: <a href="#primary-cms1157fhirhivretention-numerator">Numerator</a> 
          
        
      </td>
    </tr>
  

  


  
    
<tr>


<th scope="row" class="row-header">Supplemental Data Guidance</th>


<td class="content-container"><p>For every patient evaluated by this measure also identify payer, race, ethnicity and sex</p></td>
</tr>

  


  <tr>


<th colspan="2" scope="row" class="row-header">Supplemental Data Elements</th>


</tr>


<tr>
  

<th scope="row" class="row-header">Supplemental Data Element</th>


  <td class="content-container">
    
      <em>ID</em>: sde-ethnicity
      
      <br/>
      
    
    
      
        
          <em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
        
        <br/>
      
    
    
      <em>Description</em>: SDE Ethnicity
    
    
      
        <br/>
        
        <em>Logic Definition</em>: <a href="#cms1157fhirhivretention-sde-ethnicity">SDE Ethnicity</a> 
      
    
  </td>
</tr>

<tr>
  

<th scope="row" class="row-header">Supplemental Data Element</th>


  <td class="content-container">
    
      <em>ID</em>: sde-payer
      
      <br/>
      
    
    
      
        
          <em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
        
        <br/>
      
    
    
      <em>Description</em>: SDE Payer
    
    
      
        <br/>
        
        <em>Logic Definition</em>: <a href="#cms1157fhirhivretention-sde-payer">SDE Payer</a> 
      
    
  </td>
</tr>

<tr>
  

<th scope="row" class="row-header">Supplemental Data Element</th>


  <td class="content-container">
    
      <em>ID</em>: sde-race
      
      <br/>
      
    
    
      
        
          <em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
        
        <br/>
      
    
    
      <em>Description</em>: SDE Race
    
    
      
        <br/>
        
        <em>Logic Definition</em>: <a href="#cms1157fhirhivretention-sde-race">SDE Race</a> 
      
    
  </td>
</tr>

<tr>
  

<th scope="row" class="row-header">Supplemental Data Element</th>


  <td class="content-container">
    
      <em>ID</em>: sde-sex
      
      <br/>
      
    
    
      
        
          <em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
        
        <br/>
      
    
    
      <em>Description</em>: SDE Sex
    
    
      
        <br/>
        
        <em>Logic Definition</em>: <a href="#cms1157fhirhivretention-sde-sex">SDE Sex</a> 
      
    
  </td>
</tr>


<tr>


<th colspan="2" scope="row" class="row-header">Measure Logic</th>


</tr>

<tr>


<th scope="row" class="row-header">Primary Library</th>


<td class="content-container">https://madie.cms.gov/Library/CMS1157FHIRHIVRetention</td>
</tr>




<tr>
  <th scope="row" class="row-header">Contents</th>
  <td class="content-container">
    <em><a href="#population-criteria">Population Criteria</a></em>
    <br/>
    <em><a href="#definitions">Logic Definitions</a></em>
    <br/>
    <em><a href="#terminology">Terminology</a></em>
    <br/>
    <em><a href="#dependencies">Dependencies</a></em>
    <br/>
    <em><a href="#data-requirements">Data Requirements</a></em>
    <br/>
  </td>
</tr>


  <tr>


<th colspan="2" scope="row" class="row-header"><a name="population-criteria"> </a>Population Criteria</th>


</tr>
  
  
  
  
    
    <tr>


<th colspan="2" scope="row" class="row-header">Measure Group (Rate) (ID: Group_1)</th>


</tr>
  
  
  
  
    
      
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
            
              
            
            <tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="primary-cms1157fhirhivretention-initial-population"> </a>
    
    
    Initial Population
    
  </th>
</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot;:
  &quot;Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period&quot;
    and &quot;Has Qualifying Encounter During First 240 Days of Measurement Period&quot;</code></pre>
  </td>

</tr>

          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
      
    
  

  
    
      
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
            
              
            
            <tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="primary-cms1157fhirhivretention-denominator"> </a>
    
    
    Denominator
    
  </th>
</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Denominator&quot;:
  &quot;Initial Population&quot;</code></pre>
  </td>

</tr>

          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
      
    
  

  
    
      
        
          
        
          
        
          
        
          
        
          
        
          
            
              
            
            <tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="primary-cms1157fhirhivretention-numerator"> </a>
    
    
    Numerator
    
  </th>
</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Numerator&quot;:
  &quot;Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart&quot;
    or &quot;Has Two Encounters With HIV At Least 90 Days Apart&quot;</code></pre>
  </td>

</tr>

          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
      
    
  

  
  

  
  


  <tr>


<th colspan="2" scope="row" class="row-header"><a name="definitions"> </a>Logic Definitions</th>


</tr>
  
  
          
        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="supplementaldataelements-sde-sex"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> SupplementalDataElements</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Sex&quot;:
  case
    when Patient.sex = '248153007' then &quot;Male (finding)&quot;
    when Patient.sex = '248152002' then &quot;Female (finding)&quot;
    else null
  end</code></pre>
  </td>

</tr>



        



        



        



        



        



        



        



        



        



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="supplementaldataelements-sde-payer"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> SupplementalDataElements</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Payer&quot;:
  [Coverage: type in &quot;Payer Type&quot;] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }</code></pre>
  </td>

</tr>



        



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="supplementaldataelements-sde-ethnicity"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> SupplementalDataElements</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Ethnicity&quot;:
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }</code></pre>
  </td>

</tr>



        



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="supplementaldataelements-sde-race"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> SupplementalDataElements</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Race&quot;:
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }</code></pre>
  </td>

</tr>



        



        



        



        



        




        
        



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="cms1157fhirhivretention-sde-sex"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> CMS1157FHIRHIVRetention</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Sex&quot;:
  SDE.&quot;SDE Sex&quot;</code></pre>
  </td>

</tr>



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="cms1157fhirhivretention-encounter-during-measurement-period-with-hiv"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> CMS1157FHIRHIVRetention</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Encounter During Measurement Period With HIV&quot;:
  ( ( [&quot;Encounter&quot;: &quot;Office Visit&quot;]
      union [&quot;Encounter&quot;: &quot;Outpatient Consultation&quot;]
      union [&quot;Encounter&quot;: &quot;Annual Wellness Visit&quot;]
      union [&quot;Encounter&quot;: &quot;Face-to-Face Interaction&quot;]
      union [&quot;Encounter&quot;: &quot;Home Healthcare Services&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services Established Office Visit, 18 and Up&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services Initial Office Visit, 18 and Up&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services, Initial Office Visit, 0 to 17&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care, Established Office Visit, 0 to 17&quot;]
      union [&quot;Encounter&quot;: &quot;Telephone Visits&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services Other&quot;] ) ValidEncounter
      with ( [&quot;ConditionProblemsHealthConcerns&quot;: &quot;HIV&quot;]
        union [&quot;ConditionEncounterDiagnosis&quot;: &quot;HIV&quot;] ) HIVDiagnosis
        such that ValidEncounter.period during day of &quot;Measurement Period&quot;
          and ValidEncounter.status = 'finished'
          and HIVDiagnosis.prevalenceInterval ( ) starts on or before day of start of ValidEncounter.period
          and HIVDiagnosis.isVerified ( )
  )</code></pre>
  </td>

</tr>



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="cms1157fhirhivretention-has-one-encounter-with-hiv-and-one-viral-load-test-at-least-90-days-apart"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> CMS1157FHIRHIVRetention</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart&quot;:
  exists ( &quot;Encounter During Measurement Period With HIV&quot; ) EncounterWithHIV
    with [&quot;LaboratoryResultObservation&quot;: &quot;HIV Viral Load Tests&quot;] ViralLoadTest
      such that ViralLoadTest.status in { 'final', 'amended', 'corrected' }
        and ViralLoadTest.effective.toInterval ( ) during day of &quot;Measurement Period&quot;
        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 ( ) )
        )</code></pre>
  </td>

</tr>



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="cms1157fhirhivretention-has-two-encounters-with-hiv-at-least-90-days-apart"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> CMS1157FHIRHIVRetention</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Has Two Encounters With HIV At Least 90 Days Apart&quot;:
  exists &quot;Encounter During Measurement Period With HIV&quot; EncounterWithHIV
    with &quot;Encounter During Measurement Period With HIV&quot; AnotherEncounterWithHIV
      such that EncounterWithHIV !~ AnotherEncounterWithHIV
        and AnotherEncounterWithHIV.period starts 90 days or more after day of end of EncounterWithHIV.period</code></pre>
  </td>

</tr>



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="cms1157fhirhivretention-numerator"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> CMS1157FHIRHIVRetention</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Numerator&quot;:
  &quot;Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart&quot;
    or &quot;Has Two Encounters With HIV At Least 90 Days Apart&quot;</code></pre>
  </td>

</tr>



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="cms1157fhirhivretention-has-active-hiv-diagnosis-starts-on-or-before-first-240-days-of-measurement-period"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> CMS1157FHIRHIVRetention</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period&quot;:
  exists ( ( [&quot;ConditionProblemsHealthConcerns&quot;: &quot;HIV&quot;]
      union [&quot;ConditionEncounterDiagnosis&quot;: &quot;HIV&quot;] ) HIVDx
      where HIVDx.prevalenceInterval ( ) starts on or before day of ( start of &quot;Measurement Period&quot; + 240 days )
        and HIVDx.isVerified ( )
  )</code></pre>
  </td>

</tr>



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="cms1157fhirhivretention-has-qualifying-encounter-during-first-240-days-of-measurement-period"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> CMS1157FHIRHIVRetention</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Has Qualifying Encounter During First 240 Days of Measurement Period&quot;:
  exists ( [&quot;Encounter&quot;: &quot;Office Visit&quot;]
    union [&quot;Encounter&quot;: &quot;Outpatient Consultation&quot;]
    union [&quot;Encounter&quot;: &quot;Annual Wellness Visit&quot;]
    union [&quot;Encounter&quot;: &quot;Face-to-Face Interaction&quot;]
    union [&quot;Encounter&quot;: &quot;Home Healthcare Services&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services Established Office Visit, 18 and Up&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services Initial Office Visit, 18 and Up&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services, Initial Office Visit, 0 to 17&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care, Established Office Visit, 0 to 17&quot;]
    union [&quot;Encounter&quot;: &quot;Telephone Visits&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services Other&quot;] ) QualifyingEncounter
    where QualifyingEncounter.period during day of Interval[start of &quot;Measurement Period&quot;, start of &quot;Measurement Period&quot; + 240 days]</code></pre>
  </td>

</tr>



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="cms1157fhirhivretention-initial-population"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> CMS1157FHIRHIVRetention</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot;:
  &quot;Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period&quot;
    and &quot;Has Qualifying Encounter During First 240 Days of Measurement Period&quot;</code></pre>
  </td>

</tr>



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="cms1157fhirhivretention-denominator"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> CMS1157FHIRHIVRetention</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Denominator&quot;:
  &quot;Initial Population&quot;</code></pre>
  </td>

</tr>



        



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="cms1157fhirhivretention-sde-payer"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> CMS1157FHIRHIVRetention</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Payer&quot;:
  SDE.&quot;SDE Payer&quot;</code></pre>
  </td>

</tr>



        



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="cms1157fhirhivretention-sde-ethnicity"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> CMS1157FHIRHIVRetention</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Ethnicity&quot;:
  SDE.&quot;SDE Ethnicity&quot;</code></pre>
  </td>

</tr>



        



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="cms1157fhirhivretention-sde-race"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> CMS1157FHIRHIVRetention</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Race&quot;:
  SDE.&quot;SDE Race&quot;</code></pre>
  </td>

</tr>



        



        



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="cms1157fhirhivretention-isverified"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> CMS1157FHIRHIVRetention</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define fluent function isVerified(condition Choice&lt;QICore.ConditionProblemsHealthConcerns, QICore.ConditionEncounterDiagnosis&gt;):
  condition.verificationStatus is not null implies ( condition.verificationStatus ~ QICoreCommon.&quot;confirmed&quot;
      or condition.verificationStatus ~ QICoreCommon.&quot;unconfirmed&quot;
      or condition.verificationStatus ~ QICoreCommon.&quot;provisional&quot;
      or condition.verificationStatus ~ QICoreCommon.&quot;differential&quot;
  )</code></pre>
  </td>

</tr>



        




        
        



        



        



        



        



        



        



        



        



        



        



        



        



        



        



        



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="fhirhelpers-tostring"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> FHIRHelpers</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function ToString(value uri): value.value</code></pre>
  </td>

</tr>



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="fhirhelpers-tointerval"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> FHIRHelpers</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@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.&quot;start&quot; is null then
            Interval(period.&quot;start&quot;.value, period.&quot;end&quot;.value]
        else
            Interval[period.&quot;start&quot;.value, period.&quot;end&quot;.value]</code></pre>
  </td>

</tr>



        



        


<tr>
  <th scope="row" rowspan="2" class="row-header">
    
      
      <a name="fhirhelpers-tocode"> </a>
    
    Logic Definition
  </th>

  <td class="content-container"><em>Library Name:</em> FHIRHelpers</td>

</tr>
<tr>

  <td>
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@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
        }</code></pre>
  </td>

</tr>





  
  


  <tr>


<th colspan="2" scope="row" class="row-header"><a name="terminology"> </a>Terminology</th>


</tr>
  
  
  

 

 

 

 


<tr>
  
  
  

<th scope="row" class="row-header">Code System</th>


  
  <td class="content-container">
    
    <em>Description</em>: Code system SNOMEDCT
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://snomed.info/sct
    <br/>
    <em>Canonical URL</em>: <tt>http://snomed.info/sct</tt>
    
  </td>
</tr>
 


<tr>
  
  
  

<th scope="row" class="row-header">Code System</th>


  
  <td class="content-container">
    
    <em>Description</em>: Code system ConditionVerificationStatusCodes
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://terminology.hl7.org/CodeSystem/condition-ver-status
    <br/>
    <em>Canonical URL</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt>
    
  </td>
</tr>
 


<tr>
  
  

<th scope="row" class="row-header">Value Set</th>


  
  
  <td class="content-container">
    
    <em>Description</em>: Value set Office Visit
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
    <br/>
    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001</tt>
    
  </td>
</tr>
 


<tr>
  
  

<th scope="row" class="row-header">Value Set</th>


  
  
  <td class="content-container">
    
    <em>Description</em>: Value set Outpatient Consultation
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008
    <br/>
    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008</tt>
    
  </td>
</tr>
 


<tr>
  
  

<th scope="row" class="row-header">Value Set</th>


  
  
  <td class="content-container">
    
    <em>Description</em>: Value set Annual Wellness Visit
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240
    <br/>
    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240</tt>
    
  </td>
</tr>
 


<tr>
  
  

<th scope="row" class="row-header">Value Set</th>


  
  
  <td class="content-container">
    
    <em>Description</em>: Value set Face-to-Face Interaction
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.375
    <br/>
    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.375</tt>
    
  </td>
</tr>
 


<tr>
  
  

<th scope="row" class="row-header">Value Set</th>


  
  
  <td class="content-container">
    
    <em>Description</em>: Value set Home Healthcare Services
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
    <br/>
    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016</tt>
    
  </td>
</tr>
 


<tr>
  
  

<th scope="row" class="row-header">Value Set</th>


  
  
  <td class="content-container">
    
    <em>Description</em>: Value set Preventive Care Services Established Office Visit, 18 and Up
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
    <br/>
    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025</tt>
    
  </td>
</tr>
 


<tr>
  
  

<th scope="row" class="row-header">Value Set</th>


  
  
  <td class="content-container">
    
    <em>Description</em>: Value set Preventive Care Services Initial Office Visit, 18 and Up
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
    <br/>
    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023</tt>
    
  </td>
</tr>
 


<tr>
  
  

<th scope="row" class="row-header">Value Set</th>


  
  
  <td class="content-container">
    
    <em>Description</em>: Value set Preventive Care Services, Initial Office Visit, 0 to 17
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022
    <br/>
    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022</tt>
    
  </td>
</tr>
 


<tr>
  
  

<th scope="row" class="row-header">Value Set</th>


  
  
  <td class="content-container">
    
    <em>Description</em>: Value set Preventive Care, Established Office Visit, 0 to 17
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024
    <br/>
    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024</tt>
    
  </td>
</tr>
 


<tr>
  
  

<th scope="row" class="row-header">Value Set</th>


  
  
  <td class="content-container">
    
    <em>Description</em>: Value set Telephone Visits
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080
    <br/>
    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080</tt>
    
  </td>
</tr>
 


<tr>
  
  

<th scope="row" class="row-header">Value Set</th>


  
  
  <td class="content-container">
    
    <em>Description</em>: Value set Preventive Care Services Other
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.11.1150
    <br/>
    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.11.1150</tt>
    
  </td>
</tr>
 


<tr>
  
  

<th scope="row" class="row-header">Value Set</th>


  
  
  <td class="content-container">
    
    <em>Description</em>: Value set HIV
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003
    <br/>
    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003</tt>
    
  </td>
</tr>
 


<tr>
  
  

<th scope="row" class="row-header">Value Set</th>


  
  
  <td class="content-container">
    
    <em>Description</em>: Value set HIV Viral Load Tests
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.377
    <br/>
    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.377</tt>
    
  </td>
</tr>
 


<tr>
  
  

<th scope="row" class="row-header">Value Set</th>


  
  
  <td class="content-container">
    
    <em>Description</em>: Value set Payer Type
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
    <br/>
    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591</tt>
    
  </td>
</tr>
 


  
  <tr>
    <th scope="row" class="row-header">Direct Reference Code</th>
    <td class="content-container">
      
        <em>Display</em>: Male (finding)
        <br/>
      
      <em>Code</em>: 248153007
      <br/>
      <em>System</em>: <tt>http://snomed.info/sct</tt>
    </td>
  </tr>

  <tr>
    <th scope="row" class="row-header">Direct Reference Code</th>
    <td class="content-container">
      
        <em>Display</em>: Female (finding)
        <br/>
      
      <em>Code</em>: 248152002
      <br/>
      <em>System</em>: <tt>http://snomed.info/sct</tt>
    </td>
  </tr>

  <tr>
    <th scope="row" class="row-header">Direct Reference Code</th>
    <td class="content-container">
      
        <em>Display</em>: Confirmed
        <br/>
      
      <em>Code</em>: confirmed
      <br/>
      <em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt>
    </td>
  </tr>

  <tr>
    <th scope="row" class="row-header">Direct Reference Code</th>
    <td class="content-container">
      
        <em>Display</em>: Unconfirmed
        <br/>
      
      <em>Code</em>: unconfirmed
      <br/>
      <em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt>
    </td>
  </tr>

  <tr>
    <th scope="row" class="row-header">Direct Reference Code</th>
    <td class="content-container">
      
        <em>Display</em>: Provisional
        <br/>
      
      <em>Code</em>: provisional
      <br/>
      <em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt>
    </td>
  </tr>

  <tr>
    <th scope="row" class="row-header">Direct Reference Code</th>
    <td class="content-container">
      
        <em>Display</em>: Differential
        <br/>
      
      <em>Code</em>: differential
      <br/>
      <em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt>
    </td>
  </tr>

  
  


  <tr>


<th colspan="2" scope="row" class="row-header"><a name="dependencies"> </a>Dependencies</th>


</tr>
  
  
  


<tr>
  

<th scope="row" class="row-header">Dependency</th>


  <td class="content-container">
    
    <em>Description</em>: QICore model information
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: http://hl7.org/fhir/Library/QICore-ModelInfo
    <br/>
    <em>Canonical URL</em>: <tt>http://hl7.org/fhir/Library/QICore-ModelInfo</tt>
    
  </td>
</tr>
 


<tr>
  

<th scope="row" class="row-header">Dependency</th>


  <td class="content-container">
    
    <em>Description</em>: Library SDE
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: https://madie.cms.gov/Library/SupplementalDataElements|5.1.000
    <br/>
    <em>Canonical URL</em>: <tt>https://madie.cms.gov/Library/SupplementalDataElements|5.1.000</tt>
    
  </td>
</tr>
 


<tr>
  

<th scope="row" class="row-header">Dependency</th>


  <td class="content-container">
    
    <em>Description</em>: Library FHIRHelpers
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: https://madie.cms.gov/Library/FHIRHelpers|4.4.000
    <br/>
    <em>Canonical URL</em>: <tt>https://madie.cms.gov/Library/FHIRHelpers|4.4.000</tt>
    
  </td>
</tr>
 


<tr>
  

<th scope="row" class="row-header">Dependency</th>


  <td class="content-container">
    
    <em>Description</em>: Library QICoreCommon
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: https://madie.cms.gov/Library/QICoreCommon|4.0.000
    <br/>
    <em>Canonical URL</em>: <tt>https://madie.cms.gov/Library/QICoreCommon|4.0.000</tt>
    
  </td>
</tr>
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


  
  


  <tr>


<th colspan="2" scope="row" class="row-header"><a name="data-requirements"> </a>Data Requirements</th>


</tr>
  
  
  
<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Patient
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
    <br/>        
  
   
   
    <em>Must Support Elements</em>: extension, url
    <br/>
   
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Encounter
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
    <br/>        
  
   
   
    <em>Must Support Elements</em>: type, period, status, status.value
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: type</span>
    <br/>
  
  
  
    <span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
    <br/> 
  
  
  
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Encounter
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
    <br/>        
  
   
   
    <em>Must Support Elements</em>: type, period, status, status.value
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: type</span>
    <br/>
  
  
  
    <span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008
    <br/> 
  
  
  
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Encounter
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
    <br/>        
  
   
   
    <em>Must Support Elements</em>: type, period, status, status.value
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: type</span>
    <br/>
  
  
  
    <span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240
    <br/> 
  
  
  
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Encounter
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
    <br/>        
  
   
   
    <em>Must Support Elements</em>: type, period, status, status.value
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: type</span>
    <br/>
  
  
  
    <span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.375
    <br/> 
  
  
  
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Encounter
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
    <br/>        
  
   
   
    <em>Must Support Elements</em>: type, period, status, status.value
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: type</span>
    <br/>
  
  
  
    <span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
    <br/> 
  
  
  
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Encounter
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
    <br/>        
  
   
   
    <em>Must Support Elements</em>: type, period, status, status.value
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: type</span>
    <br/>
  
  
  
    <span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
    <br/> 
  
  
  
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Encounter
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
    <br/>        
  
   
   
    <em>Must Support Elements</em>: type, period, status, status.value
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: type</span>
    <br/>
  
  
  
    <span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
    <br/> 
  
  
  
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Encounter
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
    <br/>        
  
   
   
    <em>Must Support Elements</em>: type, period, status, status.value
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: type</span>
    <br/>
  
  
  
    <span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022
    <br/> 
  
  
  
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Encounter
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
    <br/>        
  
   
   
    <em>Must Support Elements</em>: type, period, status, status.value
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: type</span>
    <br/>
  
  
  
    <span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024
    <br/> 
  
  
  
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Encounter
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
    <br/>        
  
   
   
    <em>Must Support Elements</em>: type, period, status, status.value
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: type</span>
    <br/>
  
  
  
    <span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080
    <br/> 
  
  
  
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Encounter
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
    <br/>        
  
   
   
    <em>Must Support Elements</em>: type, period, status, status.value
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: type</span>
    <br/>
  
  
  
    <span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.11.1150
    <br/> 
  
  
  
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Condition
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
    <br/>        
  
   
   
    <em>Must Support Elements</em>: code
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: code</span>
    <br/>
  
  
  
    <span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003
    <br/> 
  
  
  
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Condition
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
    <br/>        
  
   
   
    <em>Must Support Elements</em>: code
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: code</span>
    <br/>
  
  
  
    <span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003
    <br/> 
  
  
  
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Observation
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab
    <br/>        
  
   
   
    <em>Must Support Elements</em>: code, status, status.value, effective
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: code</span>
    <br/>
  
  
  
    <span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.377
    <br/> 
  
  
  
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Coverage
    <br/>
  
    <em>Profile(s)</em>: 
  
    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage
    <br/>        
  
   
   
    <em>Must Support Elements</em>: type, period
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: type</span>
    <br/>
  
  
  
    <span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
    <br/> 
  
  
  
   
  </td>
</tr>

  
  

<tr>
  <th colspan="2" scope="row" class="row-header">Generated using version 0.4.8 of the sample-content-ig Liquid templates</th>
</tr>

    </tbody>
  </table>
</div>
  </text>
  <contained>
    <Library>
      <id value="effective-data-requirements"/>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="248153007"/>
          <display value="Male (finding)"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="248152002"/>
          <display value="Female (finding)"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
        <valueCoding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
          <code value="confirmed"/>
          <display value="Confirmed"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
        <valueCoding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
          <code value="unconfirmed"/>
          <display value="Unconfirmed"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
        <valueCoding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
          <code value="provisional"/>
          <display value="Provisional"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
        <valueCoding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
          <code value="differential"/>
          <display value="Differential"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="SupplementalDataElements"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Sex"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Sex&quot;:
  case
    when Patient.sex = '248153007' then &quot;Male (finding)&quot;
    when Patient.sex = '248152002' then &quot;Female (finding)&quot;
    else null
  end"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="0"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="CMS1157FHIRHIVRetention"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Sex"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Sex&quot;:
  SDE.&quot;SDE Sex&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="1"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="CMS1157FHIRHIVRetention"/>
        </extension>
        <extension url="name">
          <valueString value="Encounter During Measurement Period With HIV"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Encounter During Measurement Period With HIV&quot;:
  ( ( [&quot;Encounter&quot;: &quot;Office Visit&quot;]
      union [&quot;Encounter&quot;: &quot;Outpatient Consultation&quot;]
      union [&quot;Encounter&quot;: &quot;Annual Wellness Visit&quot;]
      union [&quot;Encounter&quot;: &quot;Face-to-Face Interaction&quot;]
      union [&quot;Encounter&quot;: &quot;Home Healthcare Services&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services Established Office Visit, 18 and Up&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services Initial Office Visit, 18 and Up&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services, Initial Office Visit, 0 to 17&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care, Established Office Visit, 0 to 17&quot;]
      union [&quot;Encounter&quot;: &quot;Telephone Visits&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services Other&quot;] ) ValidEncounter
      with ( [&quot;ConditionProblemsHealthConcerns&quot;: &quot;HIV&quot;]
        union [&quot;ConditionEncounterDiagnosis&quot;: &quot;HIV&quot;] ) HIVDiagnosis
        such that ValidEncounter.period during day of &quot;Measurement Period&quot;
          and ValidEncounter.status = 'finished'
          and HIVDiagnosis.prevalenceInterval ( ) starts on or before day of start of ValidEncounter.period
          and HIVDiagnosis.isVerified ( )
  )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="2"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="CMS1157FHIRHIVRetention"/>
        </extension>
        <extension url="name">
          <valueString
                       value="Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart&quot;:
  exists ( &quot;Encounter During Measurement Period With HIV&quot; ) EncounterWithHIV
    with [&quot;LaboratoryResultObservation&quot;: &quot;HIV Viral Load Tests&quot;] ViralLoadTest
      such that ViralLoadTest.status in { 'final', 'amended', 'corrected' }
        and ViralLoadTest.effective.toInterval ( ) during day of &quot;Measurement Period&quot;
        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 ( ) )
        )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="3"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="CMS1157FHIRHIVRetention"/>
        </extension>
        <extension url="name">
          <valueString
                       value="Has Two Encounters With HIV At Least 90 Days Apart"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has Two Encounters With HIV At Least 90 Days Apart&quot;:
  exists &quot;Encounter During Measurement Period With HIV&quot; EncounterWithHIV
    with &quot;Encounter During Measurement Period With HIV&quot; AnotherEncounterWithHIV
      such that EncounterWithHIV !~ AnotherEncounterWithHIV
        and AnotherEncounterWithHIV.period starts 90 days or more after day of end of EncounterWithHIV.period"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="4"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="CMS1157FHIRHIVRetention"/>
        </extension>
        <extension url="name">
          <valueString value="Numerator"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Numerator&quot;:
  &quot;Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart&quot;
    or &quot;Has Two Encounters With HIV At Least 90 Days Apart&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="5"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="CMS1157FHIRHIVRetention"/>
        </extension>
        <extension url="name">
          <valueString
                       value="Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period&quot;:
  exists ( ( [&quot;ConditionProblemsHealthConcerns&quot;: &quot;HIV&quot;]
      union [&quot;ConditionEncounterDiagnosis&quot;: &quot;HIV&quot;] ) HIVDx
      where HIVDx.prevalenceInterval ( ) starts on or before day of ( start of &quot;Measurement Period&quot; + 240 days )
        and HIVDx.isVerified ( )
  )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="6"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="CMS1157FHIRHIVRetention"/>
        </extension>
        <extension url="name">
          <valueString
                       value="Has Qualifying Encounter During First 240 Days of Measurement Period"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has Qualifying Encounter During First 240 Days of Measurement Period&quot;:
  exists ( [&quot;Encounter&quot;: &quot;Office Visit&quot;]
    union [&quot;Encounter&quot;: &quot;Outpatient Consultation&quot;]
    union [&quot;Encounter&quot;: &quot;Annual Wellness Visit&quot;]
    union [&quot;Encounter&quot;: &quot;Face-to-Face Interaction&quot;]
    union [&quot;Encounter&quot;: &quot;Home Healthcare Services&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services Established Office Visit, 18 and Up&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services Initial Office Visit, 18 and Up&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services, Initial Office Visit, 0 to 17&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care, Established Office Visit, 0 to 17&quot;]
    union [&quot;Encounter&quot;: &quot;Telephone Visits&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services Other&quot;] ) QualifyingEncounter
    where QualifyingEncounter.period during day of Interval[start of &quot;Measurement Period&quot;, start of &quot;Measurement Period&quot; + 240 days]"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="7"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="CMS1157FHIRHIVRetention"/>
        </extension>
        <extension url="name">
          <valueString value="Initial Population"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Initial Population&quot;:
  &quot;Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period&quot;
    and &quot;Has Qualifying Encounter During First 240 Days of Measurement Period&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="8"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="CMS1157FHIRHIVRetention"/>
        </extension>
        <extension url="name">
          <valueString value="Denominator"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Denominator&quot;:
  &quot;Initial Population&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="9"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="SupplementalDataElements"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Payer"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Payer&quot;:
  [Coverage: type in &quot;Payer Type&quot;] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="10"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="CMS1157FHIRHIVRetention"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Payer"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Payer&quot;:
  SDE.&quot;SDE Payer&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="11"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="SupplementalDataElements"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Ethnicity"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Ethnicity&quot;:
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="12"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="CMS1157FHIRHIVRetention"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Ethnicity"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Ethnicity&quot;:
  SDE.&quot;SDE Ethnicity&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="13"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="SupplementalDataElements"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Race"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Race&quot;:
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="14"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="CMS1157FHIRHIVRetention"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Race"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Race&quot;:
  SDE.&quot;SDE Race&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="15"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="FHIRHelpers"/>
        </extension>
        <extension url="name">
          <valueString value="ToString"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define function ToString(value uri): value.value"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="16"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="FHIRHelpers"/>
        </extension>
        <extension url="name">
          <valueString value="ToInterval"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period.&quot;start&quot; is null then
            Interval(period.&quot;start&quot;.value, period.&quot;end&quot;.value]
        else
            Interval[period.&quot;start&quot;.value, period.&quot;end&quot;.value]"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="17"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="CMS1157FHIRHIVRetention"/>
        </extension>
        <extension url="name">
          <valueString value="isVerified"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define fluent function isVerified(condition Choice&lt;QICore.ConditionProblemsHealthConcerns, QICore.ConditionEncounterDiagnosis&gt;):
  condition.verificationStatus is not null implies ( condition.verificationStatus ~ QICoreCommon.&quot;confirmed&quot;
      or condition.verificationStatus ~ QICoreCommon.&quot;unconfirmed&quot;
      or condition.verificationStatus ~ QICoreCommon.&quot;provisional&quot;
      or condition.verificationStatus ~ QICoreCommon.&quot;differential&quot;
  )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="18"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="FHIRHelpers"/>
        </extension>
        <extension url="name">
          <valueString value="ToCode"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="19"/>
        </extension>
      </extension>
      <name value="EffectiveDataRequirements"/>
      <status value="active"/>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/library-type"/>
          <code value="module-definition"/>
        </coding>
      </type>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="QICore model information"/>
        <resource value="http://hl7.org/fhir/Library/QICore-ModelInfo"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library SDE"/>
        <resource
                  value="https://madie.cms.gov/Library/SupplementalDataElements|5.1.000"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library FHIRHelpers"/>
        <resource value="https://madie.cms.gov/Library/FHIRHelpers|4.4.000"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library QICoreCommon"/>
        <resource value="https://madie.cms.gov/Library/QICoreCommon|4.0.000"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Code system SNOMEDCT"/>
        <resource value="http://snomed.info/sct"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Code system ConditionVerificationStatusCodes"/>
        <resource
                  value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Office Visit"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Outpatient Consultation"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Annual Wellness Visit"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Face-to-Face Interaction"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.375"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Home Healthcare Services"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Preventive Care Services Established Office Visit, 18 and Up"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Preventive Care Services Initial Office Visit, 18 and Up"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Preventive Care Services, Initial Office Visit, 0 to 17"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Preventive Care, Established Office Visit, 0 to 17"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Telephone Visits"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Preventive Care Services Other"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.11.1150"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set HIV"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set HIV Viral Load Tests"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.377"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Payer Type"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
      </relatedArtifact>
      <parameter>
        <name value="Measurement Period"/>
        <use value="in"/>
        <min value="0"/>
        <max value="1"/>
        <type value="Period"/>
      </parameter>
      <parameter>
        <name value="Numerator"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name value="Denominator"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name value="Initial Population"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name value="SDE Sex"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="Coding"/>
      </parameter>
      <parameter>
        <name value="SDE Payer"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Resource"/>
      </parameter>
      <parameter>
        <name value="SDE Ethnicity"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="Resource"/>
      </parameter>
      <parameter>
        <name value="SDE Race"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="Resource"/>
      </parameter>
      <dataRequirement>
        <type value="Patient"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
        <mustSupport value="extension"/>
        <mustSupport value="url"/>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.375"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.11.1150"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Condition"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"/>
        <mustSupport value="code"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Condition"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"/>
        <mustSupport value="code"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Observation"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab"/>
        <mustSupport value="code"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="effective"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.377"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Coverage"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
        </codeFilter>
      </dataRequirement>
    </Library>
  </contained>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" id="supplementalDataGuidance">
    <extension url="guidance">
      <valueString
                   value="&lt;p&gt;For every patient evaluated by this measure also identify payer, race, ethnicity and sex&lt;/p&gt;"/>
    </extension>
    <extension url="usage">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
          <code value="supplemental-data"/>
          <display value="Supplemental Data"/>
        </coding>
        <text value="Supplemental Data Guidance"/>
      </valueCodeableConcept>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm">
    <extension url="term">
      <valueString value="Month"/>
    </extension>
    <extension url="definition">
      <valueMarkdown
                     value="To maintain consistency from year to year, this measure defines one month as equal to 30 days, three months as equal to 90 days and eight months as equal to 240 days
"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements">
    <valueReference>
      <reference value="#effective-data-requirements"/>
    </valueReference>
  </extension>
  <url value="https://madie.cms.gov/Measure/CMS1157FHIRHIVRetention"/>
  <identifier>
    <use value="usual"/>
    <type>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"/>
        <code value="short-name"/>
        <display value="Short Name"/>
      </coding>
    </type>
    <system value="https://madie.cms.gov/measure/shortName"/>
    <value value="CMS1157FHIR"/>
  </identifier>
  <identifier>
    <use value="official"/>
    <type>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"/>
        <code value="version-independent"/>
        <display value="Version Independent"/>
      </coding>
    </type>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:uuid:03878bb8-1209-4f3f-91f6-52b655092251"/>
  </identifier>
  <identifier>
    <use value="official"/>
    <type>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"/>
        <code value="version-specific"/>
        <display value="Version Specific"/>
      </coding>
    </type>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:uuid:36e79353-69dd-4ca6-8d94-49fca9c67ca2"/>
  </identifier>
  <identifier>
    <use value="official"/>
    <type>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"/>
        <code value="publisher"/>
        <display value="Publisher"/>
      </coding>
    </type>
    <system value="https://madie.cms.gov/measure/cmsId"/>
    <value value="1157FHIR"/>
    <assigner>
      <display value="CMS"/>
    </assigner>
  </identifier>
  <version value="1.0.000"/>
  <name value="CMS1157FHIRHIVRetention"/>
  <title value="HIV Annual Retention in CareFHIR
"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2025-08-22T17:08:17+00:00"/>
  <publisher value="Health Resources &amp;amp; Services Administration"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value=" https://www.hrsa.gov/"/>
    </telecom>
  </contact>
  <description
               value="Percentage of patients, regardless of age, with a diagnosis of Human Immunodeficiency Virus (HIV) during the first 240 days of the measurement period or before the measurement period who had at least two eligible encounters or at least one eligible encounter and one HIV viral load test that were at least 90 days apart within the measurement period
"/>
  <usage
         value="A patient would be included in the measure numerator if they have either two eligible encounters or one eligible encounter and one viral load test at least 90 days apart from each other. The encounter or encounters that cause a patient to be included in the numerator do not need to include the encounter that caused the patient to be included in the denominator.

Only patients with an eligible encounter in the first eight months are included in this measure to allow for sufficient time to complete a second eligible encounter or viral load laboratory within the 12-month measurement period and at least 90 days after the initial encounter.

This eCQM is a patient-based measure. This measure is to be submitted a minimum of once per measurement period for patients with a diagnosis of HIV during the first eight months of the measurement period.

This FHIR-based measure has been derived from the QDM-based measure CMS1157v2. 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="This measure was developed by the Health Resources and Services Administration of the U.S. Department for Health and Human Services. It is in the public domain.

Citation of HRSA as the source of the original measure is appreciated. Any modified versions may not be represented as approved, endorsed, or authorized by HRSA or HHS. 42 U.S.C. Section 1320b-10. Users of modified versions should clearly explain how they deviate from HRSA's original measure.

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.

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. ICD-10 is copyright 2024 World Health Organization. All Rights Reserved.

Due to technical limitations, registered trademarks are indicated by (R) or \[R\] and unregistered trademarks are indicated by (TM) or \[TM\].
"/>
  <effectivePeriod>
    <start value="2026-01-01"/>
    <end value="2026-12-31"/>
  </effectivePeriod>
  <author>
    <name value="Health Resources &amp;amp; Services Administration"/>
    <telecom>
      <system value="url"/>
      <value value=" https://www.hrsa.gov/"/>
    </telecom>
  </author>
  <relatedArtifact>
    <type value="citation"/>
    <citation
              value="Crawford, T. N., Sanderson, W. T., \&amp; Thornton, A. (2014). Impact of Poor Retention in HIV Medical Care on Time to Viral Load Suppression. Journal of the International Association of Providers of AIDS Care (JIAPAC), 13(3), 242--249. https://doi.org/10.1177/2325957413491431.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation
              value="Gardner, E. M., McLees, M. P., Steiner, J. F., Del Rio, C., \&amp; Burman, W. J. (2011). The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 52(6), 793--800. https://doi.org/10.1093/cid/ciq243.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation
              value="Giordano, T. P., Gifford, A. L., White, A. C., Suarez-Almazor, M. E., Rabeneck, L., Hartman, C., Backus, L. I., Mole, L. A., \&amp; Morgan, R. O. (2007). Retention in care: A challenge to survival with HIV infection. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 44(11), 1493-1499. https://doi.org/10.1086/516778.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation
              value="Giordano, T. P., White, A. C., Sajja, P., Graviss, E. A., Arduino, R. C., Adu-Oppong, A., Lahart, C. J., \&amp; Visnegarwala, F. (2003). Factors associated with the use of highly active antiretroviral therapy in patients newly entering care in an urban clinic. Journal of Acquired Immune Deficiency Syndromes (JAIDS), 32(4), 399-405. https://doi.org/10.1097/00126334-200304010-00009
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation
              value="Mugavero, M. J., Lin, H.-Y., Willig, J. H., Westfall, A. O., Ulett, K. B., Routman, J. S., Abroms, S., Raper, J. L., Saag, M. S., \&amp; Allison, J. J. (2009). Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 48(2), 248--256. https://doi.org/10.1086/595705
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation
              value="Panel on Antiretroviral Guidelines for Adults and Adolescents. &quot;Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV.&quot; Washington, DC: U.S. Department of Health and Human Services, 2022. Available at https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf Updated September 21, 2022. Accessed December 15, 2022.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation
              value="Thompson, M. A., Mugavero, M. J., Amico, K. R., Cargill, V. A., Chang, L. W., Gross, R., Orrell, C., Altice, F. L., Bangsberg, D. R., Bartlett, J. G., Beckwith, C. G., Dowshen, N., Gordon, C. M., Horn, T., Kumar, P., Scott, J. D., Stirratt, M. J., Remien, R. H., Simoni, J. M., \&amp; Nachega, J. B. (2012). Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care panel. Annals of internal medicine, 156(11), 817-294. https://doi.org/10.7326/0003-4819-156-11-201206050-00419
"/>
  </relatedArtifact>
  <library value="https://madie.cms.gov/Library/CMS1157FHIRHIVRetention"/>
  <disclaimer
              value="These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; 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="The HIV &quot;continuum of care&quot; is the process of HIV testing, linkage to HIV care, initiation of antiretroviral therapy (ART), adherence to treatment, retention in care, and virologic suppression (Gardner et al 2011). Poor retention in care is associated with lower rates of ART use (Giordano et al 2003), delayed viral suppression (Crawford et al 2014), and increased risk of mortality (Giordano et al., 2007; Mugavero et al., 2009). This measure will help providers direct their attention and quality improvement efforts towards improving retention in care.
"/>
  <clinicalRecommendationStatement
                                   value="&quot;Retention in care should be routinely monitored. There are various ways to measure retention, including measures based on attended visits over a defined period of time (constancy measures) and measures based on missed visits. Both approaches are valid and independently predict survival. Missed visits and a prolonged time since the last visit are relatively easy to measure and should trigger efforts to retain or re-engage a person in care. Constancy measures (e.g., at least two visits that are at least 90 days apart over 1 year or at least one visit every 6 months over the last 2 years) can be used as clinic quality assurance measures&quot; (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. L-4).

&quot;Poor retention in HIV care is associated with greater risk of death. Poor retention is more common in people who use substances, have serious mental health problems, have unmet socioeconomic needs (e.g., housing, food, transportation), lack financial resources or health insurance, have schedules that complicate adherence, have been recently incarcerated, or face stigma. At the provider and health system level, low trust in providers and a poor patient-provider relationship have been associated with lower retention, as has lower satisfaction with the clinic experience. Availability of appointments and timeliness of appointments (i.e., long delay from the request for an appointment to the appointment's date) and scheduling convenience are also factors&quot; (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. L-3).

&quot;Recommendation 2: Systematic monitoring of retention in HIV care is recommended for all patients (II A): Retention in care is associated with improved individual health outcomes, including HIV biomarker and clinical variables, and may reduce community-level viral burden, with implications for secondary prevention. Although monitoring retention is routinely recommended, specific details, such as retention measures to be used and desired visit frequency, vary among jurisdictions and programs and should be in harmony with national and international guidelines. Many retention measures (for example, visit adherence, gaps in care, and visits per interval of time) and data sources (for example, surveillance, medical records, and administrative databases) have been used and may be applied in accordance with local resources and standards of care. As with monitoring of linkage, integration of data sources may enhance monitoring of retention&quot; (Thompson et al., 2012, p. 4).
"/>
  <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="All patients, regardless of age, with a diagnosis of HIV during the first 240 days of the measurement period or before the measurement period who had at least one eligible encounter during the first 240 days 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="Numerator_1">
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="numerator"/>
          <display value="Numerator"/>
        </coding>
      </code>
      <description
                   value="Number of patients who had at least one eligible encounter and one HIV viral load test at least 90 days apart during the measurement period, or who had at least two eligible encounters at least 90 days apart during the measurement period
"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Numerator"/>
      </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>