define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 13
    and "First SUD Episode During Measurement Period" is not null
    and not exists "History of SUD Diagnosis or Treatment"

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"

define "Numerator 1":
  exists "Treatment Initiation With Non Medication Intervention Dates"
    or exists "Treatment Initiation With Medication Order Dates"

define "Stratification 1":
  AgeInYearsAt(date from start of "Measurement Period") in Interval[13, 17]

define "Stratification 2":
  AgeInYearsAt(date from start of "Measurement Period") in Interval[18, 64]

define "Stratification 3":
  AgeInYearsAt(date from start of "Measurement Period") >= 65

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 13
    and "First SUD Episode During Measurement Period" is not null
    and not exists "History of SUD Diagnosis or Treatment"

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"

define "Numerator 2":
  "Has Treatment Engagement With Long Acting Medication"
    or "Has Two or More Treatment Engagements With Short Acting Medication or Non Medication Intervention"

define "Stratification 1":
  AgeInYearsAt(date from start of "Measurement Period") in Interval[13, 17]

define "Stratification 2":
  AgeInYearsAt(date from start of "Measurement Period") in Interval[18, 64]

define "Stratification 3":
  AgeInYearsAt(date from start of "Measurement Period") >= 65

define "Has Hospice Services":
  exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter
      where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
          or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
      )
        and InpatientEncounter.period ends during day of "Measurement Period"
  )
    or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter
        where HospiceEncounter.period overlaps day of "Measurement Period"
    )
    or exists ((([ObservationScreeningAssessment: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment
        where HospiceAssessment.value ~ "Yes (qualifier value)"
          and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder
        where HospiceOrder.authoredOn during day of "Measurement Period"
    )
    or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed
        where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([ConditionProblemsHealthConcerns: "Hospice Diagnosis"]
        union [ConditionEncounterDiagnosis: "Hospice Diagnosis"]).verified()) HospiceCareDiagnosis
        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
    )

define "SDE Sex":
  case
    when Patient.sex = '248153007' then "Male (finding)"
    when Patient.sex = '248152002' then "Female (finding)"
    else null
  end

define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }

define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }

define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }

define "SDE Sex":
  SDE."SDE Sex"

define "Stratification 3":
  AgeInYearsAt(date from start of "Measurement Period") >= 65

define "Stratification 2":
  AgeInYearsAt(date from start of "Measurement Period") in Interval[18, 64]

define "Stratification 1":
  AgeInYearsAt(date from start of "Measurement Period") in Interval[13, 17]

define "Qualifying Encounters":
  ( [Encounter: "Office Visit"]
      union [Encounter: "Emergency Department Evaluation and Management Visit"]
      union [Encounter: "Detoxification Visit"]
      union [Encounter: "Initial Hospital Inpatient Visit"]
      union [Encounter: "Discharge Services Hospital Inpatient Same Day Discharge"]
      union [Encounter: "Discharge Services Hospital Inpatient"]
      union [Encounter: "Telephone Visits"]
      union [Encounter: "Virtual Encounter"]
  ).isEncounterPerformed ( )

define "First SUD Episode During Measurement Period":
  First(("Qualifying Encounters") ValidEncounters
      with(([ConditionEncounterDiagnosis: "Substance Use Disorder"]).verified()) SUDDiagnosis
        such that ValidEncounters.period during "Measurement Period"
          and SUDDiagnosis.prevalenceInterval() starts during ValidEncounters.period
          and SUDDiagnosis.prevalenceInterval() starts 47 days or more before day of 
          end of "Measurement Period"
      return {
        ValidEncounterDate: date from start of ValidEncounters.period,
        ValidEncounter: ValidEncounters
      }
      sort by ValidEncounterDate
  ).ValidEncounter

define "Emergency Department or Detoxification Visit":
  ( [Encounter: "Emergency Department Evaluation and Management Visit"]
      union [Encounter: "Detoxification Visit"]
  ).isEncounterPerformed ( )

define "History of SUD Diagnosis or Treatment":
  ( ( ( [Procedure: "Substance Use Disorder Treatment"]
        union [Procedure: "Psych Visit Psychotherapy"]
        union [Procedure: "Substance Use Disorder Long Acting Medication Administration"]
        union [Procedure: "Substance Use Disorder Short Acting Medication Administration"]
    ).isInterventionPerformed ( ) ) Interventions
      with "First SUD Episode During Measurement Period" FirstSUDEpisode
        such that Interventions.performed.toInterval ( ) starts 60 days or less before day of date from start of FirstSUDEpisode.period
  )
    union ( ( ( "Qualifying Encounters"
        except "Emergency Department or Detoxification Visit" ) QualifyingEncounter
        where QualifyingEncounter.encounterDiagnosis ( ).code in "Substance Use Disorder" ) SUDEncounterDx
        with "First SUD Episode During Measurement Period" FirstSUDEpisode
          such that SUDEncounterDx.period starts 60 days or less before day of date from start of FirstSUDEpisode.period
    )
    union ( ( ( [MedicationRequest: "Substance Use Disorder Long Acting Medication"]
          union [MedicationRequest: "Substance Use Disorder Short Acting Medication"]
      ).isMedicationOrder ( ) ) SUDMedication
        with "First SUD Episode During Measurement Period" FirstSUDEpisode
          such that SUDMedication.authoredOn 60 days or less before day of date from start of FirstSUDEpisode.period
    )

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 13
    and "First SUD Episode During Measurement Period" is not null
    and not exists "History of SUD Diagnosis or Treatment"

define "Denominator":
  "Initial Population"

define "Psychosocial Visit":
  ( ( [Procedure: "Substance Use Disorder Treatment"]
        union [Procedure: "Psych Visit Psychotherapy"]
    ).isInterventionPerformed ( )
  )
    union ( ( [Encounter: "Telephone Visits"]
        union [Encounter: "Virtual Encounter"]
    ).isEncounterPerformed ( ) ) TelehealthEncounter
      where TelehealthEncounter.encounterDiagnosis ( ).code in "Substance Use Disorder"

define "Treatment Initiation With Non Medication Intervention Dates":
  ( "Psychosocial Visit" PsychosocialVisitProcedure
      let treatmentDate: date from start of PsychosocialVisitProcedure.performed.toInterval ( )
      with "First SUD Episode During Measurement Period" FirstSUDEpisode
        such that treatmentDate during Interval[date from start of FirstSUDEpisode.period, date from start of FirstSUDEpisode.period + 14 days )
          and PsychosocialVisitProcedure.id !~ FirstSUDEpisode.id
      return all treatmentDate
  )
    union ( "Psychosocial Visit" PsychosocialVisitEncounter
        let treatmentDate: date from start of PsychosocialVisitEncounter.period
        with "First SUD Episode During Measurement Period" FirstSUDEpisode
          such that treatmentDate during Interval[date from start of FirstSUDEpisode.period, date from start of FirstSUDEpisode.period + 14 days )
            and PsychosocialVisitEncounter.id !~ FirstSUDEpisode.id
        return all treatmentDate
    )

define "Treatment Initiation With Medication Order Dates":
  ( ( ( [MedicationRequest: "Substance Use Disorder Short Acting Medication"]
        union [MedicationRequest: "Substance Use Disorder Long Acting Medication"]
    ).isMedicationOrder ( ) ) SUDMedication
      let treatmentDate: date from start of SUDMedication.authoredOn.toInterval ( )
      with "First SUD Episode During Measurement Period" FirstSUDEpisode
        such that treatmentDate during Interval[date from start of FirstSUDEpisode.period, date from start of FirstSUDEpisode.period + 14 days )
      return all treatmentDate
  )
    union ( ( ( [Procedure: "Substance Use Disorder Short Acting Medication Administration"]
          union [Procedure: "Substance Use Disorder Long Acting Medication Administration"]
      ).isProcedurePerformed ( ) ) SUDMedAdministration
        let treatmentDate: date from start of SUDMedAdministration.performed.toInterval ( )
        with "First SUD Episode During Measurement Period" FirstSUDEpisode
          such that treatmentDate during Interval[date from start of FirstSUDEpisode.period, date from start of FirstSUDEpisode.period + 14 days )
        return all treatmentDate
    )

define "Numerator 1":
  exists "Treatment Initiation With Non Medication Intervention Dates"
    or exists "Treatment Initiation With Medication Order Dates"

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

define "Has Treatment Engagement With Long Acting Medication":
  exists ( ( ( ( [MedicationRequest: "Substance Use Disorder Long Acting Medication"] ).isMedicationOrder ( ) ) LongActingMedOrder
        with ( Min("Treatment Initiation With Non Medication Intervention Dates"
            union "Treatment Initiation With Medication Order Dates"
        ) ) InitiationTreatmentDate
          such that date from start of LongActingMedOrder.authoredOn.toInterval ( ) 34 days or less after InitiationTreatmentDate
    )
      union ( ( ( [Procedure: "Substance Use Disorder Long Acting Medication Administration"] ).isProcedurePerformed ( ) ) LongActingTreatment
          with ( Min("Treatment Initiation With Non Medication Intervention Dates"
              union "Treatment Initiation With Medication Order Dates"
          ) ) InitiationTreatmentDate
            such that date from start of LongActingTreatment.performed.toInterval ( ) 34 days or less after InitiationTreatmentDate
      )
  )

define "Has Two or More Treatment Engagements With Short Acting Medication or Non Medication Intervention":
  Count((("Psychosocial Visit"
        union(([Procedure: "Substance Use Disorder Short Acting Medication Administration"]).isProcedurePerformed())) ShortActingTreatment
        with(Min("Treatment Initiation With Non Medication Intervention Dates"
            union "Treatment Initiation With Medication Order Dates"
        )) InitiationTreatmentDate
          such that date from start of ShortActingTreatment.performed.toInterval() 34 days or less after InitiationTreatmentDate
            or date from start of ShortActingTreatment.period 34 days or less after InitiationTreatmentDate
        return all ShortActingTreatment
    )
      union((([MedicationRequest: "Substance Use Disorder Short Acting Medication"]).isMedicationOrder()) ShortActingMedOrder
          with(Min("Treatment Initiation With Non Medication Intervention Dates"
              union "Treatment Initiation With Medication Order Dates"
          )) InitiationTreatmentDate
            such that date from start of ShortActingMedOrder.authoredOn.toInterval() 34 days or less after InitiationTreatmentDate
          return all ShortActingMedOrder
      )
  ) >= 2

define "Numerator 2":
  "Has Treatment Engagement With Long Acting Medication"
    or "Has Two or More Treatment Engagements With Short Acting Medication or Non Medication Intervention"

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

define "Denominator Exclusions":
  Hospice."Has Hospice Services"

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

/*  
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter  
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
  Encounter.reasonReference D
    return singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where D.references(C.id))

/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval<DateTime> then
  		choice as Interval<DateTime>
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval<Quantity> then
		  Interval[Patient.birthDate + (choice.low as Quantity),
			  Patient.birthDate + (choice.high as Quantity) + 1 year)
		when choice is Timing then
      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
		else
			null as Interval<DateTime>
	end

/*
@description: Returns true if the given reference is to the given resourceId
@comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resourceId String):
  resourceId = Last(Split(reference.reference, '/'))

define function ToString(value uri): value.value

/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]

/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }

//Encounter, Performed
//General usage unless required otherwise by measure intent (e.g., follow-up encounters)
define fluent function isEncounterPerformed(Enc List<Encounter>):
  Enc E
    where E.status = 'finished'

//This library contains functions used to constrain FHIR resource elements for measures authored by NCQA, based on QICore 6.0.0 resources including IG and authoring patterns. The functions may appear similar to some QICoreCommon functions but differ in that they have constraints that are relevant for measures authored by NCQA.

//Condition
//Returns conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential
define fluent function verified(conditions List<Choice<ConditionProblemsHealthConcerns, ConditionEncounterDiagnosis>>):
  conditions C
    where C.verificationStatus is not null implies
      (C.verificationStatus ~ "confirmed"
        or C.verificationStatus ~ "unconfirmed"
        or C.verificationStatus ~ "provisional"
        or C.verificationStatus ~ "differential"
      )

//Intervention, Performed
define fluent function isInterventionPerformed(Proc List<Procedure>):
  Proc P
    where P.status ~ 'completed'

//Medication, Order
define fluent function isMedicationOrder(MedicationRequest List<MedicationRequest>):
  MedicationRequest M
    where M.status in { 'active', 'completed' }
    and M.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}

//Procedure, Performed
define fluent function isProcedurePerformed(Proc List<Procedure>):
  Proc P
    where P.status ~ 'completed'

//Assessment, Performed
define fluent function isAssessmentPerformed(Obs List<ObservationScreeningAssessment>):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }

//Intervention, Order
define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):
  ServiceRequest S
    where S.status in { 'active', 'completed' }
      and S.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}