eCQM QICore Content Implementation Guide
2024.0.0 - CI Build

eCQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2024.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/ecqm-content-qicore-2024/ and changes regularly. See the Directory of published versions

: Primary Caries Prevention Intervention as Offered by DentistsFHIR - JSON Representation

Draft as of 2024-12-18

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{
  "resourceType" : "Measure",
  "id" : "PrimaryCariesPreventionasOfferedbyDentistsFHIR",
  "meta" : {
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      🔗 "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"🔗 ,
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"🔗 ,
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n    <table class=\"grid dict\">\n        \n            <tr>\n                <th scope=\"row\"><b>Title: </b></th>\n                <td style=\"padding-left: 4px;\">Primary Caries Prevention Intervention as Offered by DentistsFHIR</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Id: </b></th>\n                <td style=\"padding-left: 4px;\">PrimaryCariesPreventionasOfferedbyDentistsFHIR</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Version: </b></th>\n                <td style=\"padding-left: 4px;\">0.0.002</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Url: </b></th>\n                <td style=\"padding-left: 4px;\"><a href=\"Measure-PrimaryCariesPreventionasOfferedbyDentistsFHIR.html\">Primary Caries Prevention Intervention as Offered by DentistsFHIR</a></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                short-name identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>CMS74FHIR</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                version-independent identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>urn:uuid:1c99917f-438b-4cdb-ba95-d2fb32f9d715</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                version-specific identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>urn:uuid:d28e85be-55aa-470f-8138-e13fa160159b</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                publisher (CMS) identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>74FHIR</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Effective Period: </b></th>\n                <td style=\"padding-left: 4px;\">2025-01-01..2025-12-31</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Status: </b></th>\n                <td style=\"padding-left: 4px;\">draft</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Publisher: </b></th>\n                <td style=\"padding-left: 4px;\">Centers for Medicare &amp; Medicaid Services (CMS)</td>\n            </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Author: </b></th>\n            <td style=\"padding-left: 4px;\">National Committee for Quality Assurance</td>\n        </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Description: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>Percentage of children, 1-20 years of age, who received two fluoride varnish applications during the measurement period as determined by a dentist</p>\n</div></td>\n            </tr>\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Purpose: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>UNKNOWN</p>\n</div></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Copyright: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare &amp; Medicaid Services (CMS). CMS contracted (Contract HHSP23320095627WC; HHSP23337008T) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications.</p>\n<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. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications.</p>\n<p>CPT(R) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use.</p>\n<p>The American Dental Association (“ADA”) holds a copyright to the Current Dental Terminology (“CDT”) codes contained in certain measure specifications. The CDT codes in the measure specifications are included with the permission of the ADA. All uses of the CDT codes require a license from the ADA. No alteration, amendments, or modifications of the CDT or any portion thereof is allowed. Resale, transmission, or distribution of copies of the CDT or other portions of the CDT is also not allowed. To inquire about licensing, contact CDT-SNODENT@ada.org.</p>\n<p>The measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use.</p>\n<p>This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation.</p>\n<p>ICD-10 copyright 2024 World Health Organization. All Rights Reserved.</p>\n<p>“HL7” is the registered trademark of Health Level Seven International.</p>\n</div></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Disclaimer: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.</p>\n<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>\n</div></td>\n            </tr>\n        \n\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Scoring: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    \n                        \n                            <p style=\"margin-bottom: 5px;\">\n                                <span>Proportion </span>\n                            </p>\n                        \n                    \n                    \n                </td>\n            </tr>\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Rationale: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>The literature reflects that fluoride varnish, when applied to the teeth of high-risk children, reduces, in conjunction with anticipatory guidance provided to the caregiver, the risk of the child developing caries (Weyant et al., 2013). Evidence in the literature also specifically supports the effectiveness of professionally applied fluoride varnish at preventing caries in higher risk children (Chou et al., 2014).</p>\n</div></td>\n        </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Clinical recommendation statement: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>The 2013 American Dental Association (ADA) clinical recommendations for use of professionally applied or prescription-strength, home-use topical fluorides for caries prevention in patients at elevated risk of developing caries:</p>\n<ul>\n<li>\n<p>Younger Than 6 Years - 2.26 percent fluoride varnish at least every three to six months.</p>\n</li>\n<li>\n<p>6-18 Years - 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF*) gel for four minutes at least every three to six months.</p>\n</li>\n<li>\n<p>Older Than 18 Years - 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF) gel for four minutes at least every three to six months (Weyant et al., 2013).</p>\n</li>\n</ul>\n<p>The United States Preventive Services Taskforce (USPSTF) recommends the use of professionally applied fluoride varnish for the prevention of dental caries in high risk children under 5 years of age (Chou et al., 2014).</p>\n</div></td>\n        </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Guidance (Usage): </b></th>\n                <td style=\"padding-left: 4px;\">This eCQM is a patient-based measure.\n\nTelehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible codes and requires a clinical action that cannot be conducted via telehealth.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS74v14.\n\nPlease refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).</td>\n            </tr>\n        \n\n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Population Criteria: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <table class=\"grid-dict\">\n                                \n                                    <tr>\n                                        <th><b>64e664622ad653247b573aea</b></th>\n                                    </tr>\n                                \n                                \n                                    <tr>\n                                        <td>Initial Population:</td>\n\n                                        \n                                            \n                                                <td>Children, 1-20 years of age at the start of the measurement period, with a clinical oral evaluation by a dentist during the measurement period</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator:</td>\n\n                                        \n                                            \n                                                <td>Equals Initial Population</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator Exclusion:</td>\n\n                                        \n                                            \n                                                <td>Exclude patients who are in hospice care for any part of the measurement period</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Numerator:</td>\n\n                                        \n                                            \n                                                <td>Children who receive two fluoride varnish applications on different days during the measurement period</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                \n                                  <tr><b>Stratifier Criteria: </b></tr>\n                                    \n                                        <tr>\n                                            \n                                                <td>Stratum:</td>\n                                            \n\n                                            \n                                                <td>Population 1: Patients age 1-5 years at the start of the Measurement Period  </td>\n                                            \n                                        </tr>\n                                    \n                                        <tr>\n                                            \n                                                <td>Stratum:</td>\n                                            \n\n                                            \n                                                <td>Population 2: Patients age 6-12 years at the start of the Measurement Period </td>\n                                            \n                                        </tr>\n                                    \n                                        <tr>\n                                            \n                                                <td>Stratum:</td>\n                                            \n\n                                            \n                                                <td>Population 3: Patients age 13-20 years at the start of the Measurement Period</td>\n                                            \n                                        </tr>\n                                    \n                                \n                            </table>\n                        \n                    </td>\n                </tr>\n            \n        \n\n        \n\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Libraries: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    <table class=\"grid-dict\">\n                        \n                            <tr>\n                                <td><a href=\"Library-PrimaryCariesPreventionasOfferedbyDentistsFHIR.html\">PrimaryCariesPreventionasOfferedbyDentistsFHIR</a></td>\n                            </tr>\n                        \n                    </table>\n                </td>\n            </tr>\n        \n\n        \n\n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Terminology and Other Dependencies: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <li><code>Library/Status|1.8.000</code></li>\n                        \n                            <li><code>Library/QICoreCommon|2.1.000</code></li>\n                        \n                            <li><code>Library/FHIRHelpers|4.4.000</code></li>\n                        \n                            <li><code>Library/Hospice|6.12.000</code></li>\n                        \n                            <li><a href=\"http://hl7.org/fhir/R4/codesystem-snomedct.html\">SNOMED CT (all versions)</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-observation-category.html\">Observation Category Codes</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">Logical Observation Identifiers, Names and Codes (LOINC)</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.125.12.1002/expansion\">Fluoride Varnish Application for Children</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.125.12.1003/expansion\">Clinical Oral Evaluation</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion\">Hospice Care Ambulatory</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165</a></li>\n                        \n                    </td>\n                </tr>\n                <tr>\n                    <th scope=\"row\"><b>Parameters:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>name</b></th>\n                                <th><b>use</b></th>\n                                <th><b>min</b></th>\n                                <th><b>max</b></th>\n                                <th><b>type</b></th>\n                            </tr>\n                            \n                                <tr>\n                                    <td>Measurement Period</td>\n                                    <td>In</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Period</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Numerator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Stratification 3</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Stratification 2</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Stratification 1</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Initial Population</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator Exclusions</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n\n                <tr>\n                    <th scope=\"row\"><b>DataRequirements:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>Resource Type</b></th>\n                                <th><b>Resource Elements</b></th>\n                                <th><b>Valueset Name</b></th>\n                                <th><b>Valueset</b></th>\n                            </tr>\n                            \n                                <tr>\n                                    <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html\">QICoreProcedure</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            performed\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Fluoride Varnish Application for Children\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.125.12.1002/expansion\">Fluoride Varnish Application for Children</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html\">QICoreProcedure</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            performed\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Hospice Care Ambulatory\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion\">Hospice Care Ambulatory</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Clinical Oral Evaluation\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.125.12.1003/expansion\">Clinical Oral Evaluation</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            hospitalization\n                                        \n                                            hospitalization.dischargeDisposition\n                                        \n                                            period\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Encounter Inpatient\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Hospice Encounter\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            value\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            category\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>ServiceRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html\">QICoreServiceRequest</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Hospice Care Ambulatory\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion\">Hospice Care Ambulatory</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Hospice Diagnosis\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165</a></td>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n\n                \n                    <tr>\n                        <th scope=\"row\"><b>Direct Reference Codes:</b></th>\n                        <td style=\"padding-left: 4px;\">\n                            <table class=\"grid-dict\">\n                                <tr>\n                                    <th><b>display</b></th>\n                                    <th><b>code</b></th>\n                                    <th><b>system</b></th>\n                                </tr>\n                                \n                                    <tr>\n                                        <td>Discharge to home for hospice care (procedure)</td>\n                                        <td>428361000124107</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Discharge to healthcare facility for hospice care (procedure)</td>\n                                        <td>428371000124100</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>survey</td>\n                                        <td>survey</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-observation-category.html\">http://terminology.hl7.org/CodeSystem/observation-category</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Yes (qualifier value)</td>\n                                        <td>373066001</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Hospice care [Minimum Data Set]</td>\n                                        <td>45755-6</td>\n                                        <td><a href=\"https://loinc.org/\">http://loinc.org</a></td>\n                                    </tr>\n                                \n                            </table>\n                        </td>\n                    </tr>\n                \n\n                \n                <tr>\n                    <th scope=\"row\"><b>Logic Definitions:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>Group</b></th>\n                                <th><b>Scoring</b></th>\n                                <th><b>Population Criteria</b></th>\n                                <th><b>Expression</b></th>\n                            </tr>\n                            <tr>\n                                \n                                <td> 64e664622ad653247b573aea </td>\n                                <td colspan=\"3\" style=\"padding-left: 4px;\">\n                                    \n                                        <b>Group scoring:</b>\n                                        \n                                            <span>  proportion </span>\n                                        \n                                    \n\n                                    \n\n                                    \n                                        <b>Measure scoring:</b>\n                                        \n                                            <p style=\"margin-bottom: 5px;\">\n                                                <span>Proportion</span>\n                                            </p>\n                                        \n                                    \n\n                                    \n\n                                    \n                                        <tr>\n                                        \n                                            <th scope=\"row\"><b>Type: </b></th>\n                                            <td style=\"padding-left: 4px;\">\n                                                \n                                                    \n                                                        <p style=\"margin-bottom: 5px;\">\n                                                            <span>Process </span>\n                                                        </p>\n                                                    \n                                                \n                                                \n                                            </td>\n                                        \n                                        </tr>\n                                    \n\n                                    \n\n                                    \n                                    <tr>\n                                        <th scope=\"row\"><b>Rate Aggregation: </b></th>\n                                        <td colspan=\"3\" style=\"padding-left: 4px;\">None</td>\n                                    </tr>\n                                    \n\n                                    \n                                        <tr>\n                                            <th scope=\"row\"><b>Improvement Notation: </b></th>\n                                            <td style=\"padding-left: 4px;\">\n                                            \n                                                \n                                                    \n                                                        <p style=\"margin-bottom: 5px;\">\n                                                            <span>increase </span>\n                                                        </p>\n                                                    \n                                                \n                                                \n                                            \n                                            </td>\n                                        </tr>\n                                    \n\n                                    \n\n                                </td>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Initial Population</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  AgeInYearsAt(date from start of &quot;Measurement Period&quot;) in Interval[1, 20]\n    and exists ( &quot;Qualifying Encounters&quot; )</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Denominator&quot;:\n  &quot;Initial Population&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator Exclusion</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Denominator Exclusions&quot;:\n  Hospice.&quot;Has Hospice Services&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Numerator</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Numerator&quot;:\n  Count((([Procedure: &quot;Fluoride Varnish Application for Children&quot;]).isProcedurePerformed()) FluorideApplication\n      where FluorideApplication.performed.toInterval() ends during day of &quot;Measurement Period&quot;\n      return distinct date from \n      end of FluorideApplication.performed.toInterval()\n  ) &gt;= 2</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td/>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\"/></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td/>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\"/></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td/>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\"/></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                            \n                            </tr>\n                        </table>\n                \n\n                <table class=\"grid-dict\">\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>PrimaryCariesPreventionasOfferedbyDentistsFHIR</td>\n                            \n                            \n                                <td>Numerator</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Numerator&quot;:\n  Count((([Procedure: &quot;Fluoride Varnish Application for Children&quot;]).isProcedurePerformed()) FluorideApplication\n      where FluorideApplication.performed.toInterval() ends during day of &quot;Measurement Period&quot;\n      return distinct date from \n      end of FluorideApplication.performed.toInterval()\n  ) &gt;= 2</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>PrimaryCariesPreventionasOfferedbyDentistsFHIR</td>\n                            \n                            \n                                <td>Stratification 3</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Stratification 3&quot;:\n  AgeInYearsAt(date from start of &quot;Measurement Period&quot;) in Interval[13, 20]</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>PrimaryCariesPreventionasOfferedbyDentistsFHIR</td>\n                            \n                            \n                                <td>Stratification 2</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Stratification 2&quot;:\n  AgeInYearsAt(date from start of &quot;Measurement Period&quot;) in Interval[6, 12]</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>PrimaryCariesPreventionasOfferedbyDentistsFHIR</td>\n                            \n                            \n                                <td>Stratification 1</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Stratification 1&quot;:\n  AgeInYearsAt(date from start of &quot;Measurement Period&quot;) in Interval[1, 5]</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>PrimaryCariesPreventionasOfferedbyDentistsFHIR</td>\n                            \n                            \n                                <td>Qualifying Encounters</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Qualifying Encounters&quot;:\n  ( ( [Encounter: &quot;Clinical Oral Evaluation&quot;] ).isEncounterPerformed ( ) ) ValidEncounter\n    where ValidEncounter.period during day of &quot;Measurement Period&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>PrimaryCariesPreventionasOfferedbyDentistsFHIR</td>\n                            \n                            \n                                <td>Initial Population</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  AgeInYearsAt(date from start of &quot;Measurement Period&quot;) in Interval[1, 20]\n    and exists ( &quot;Qualifying Encounters&quot; )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>PrimaryCariesPreventionasOfferedbyDentistsFHIR</td>\n                            \n                            \n                                <td>Denominator</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator&quot;:\n  &quot;Initial Population&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>Hospice</td>\n                            \n                            \n                                <td>Has Hospice Services</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Hospice Services&quot;:\n  exists ((([Encounter: &quot;Encounter Inpatient&quot;]).isEncounterPerformed()) InpatientEncounter\n      where (InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to home for hospice care (procedure)&quot;\n          or InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to healthcare facility for hospice care (procedure)&quot;\n      )\n        and InpatientEncounter.period.toInterval() ends during day of &quot;Measurement Period&quot;\n  )\n    or exists ((([Encounter: &quot;Hospice Encounter&quot;]).isEncounterPerformed()) HospiceEncounter\n        where HospiceEncounter.period.toInterval() overlaps day of &quot;Measurement Period&quot;\n    )\n    or exists ((([Observation: &quot;Hospice care [Minimum Data Set]&quot;]).isAssessmentPerformed()) HospiceAssessment\n        where HospiceAssessment.value ~ &quot;Yes (qualifier value)&quot;\n          and HospiceAssessment.effective.toInterval() overlaps day of &quot;Measurement Period&quot;\n    )\n    or exists ((([ServiceRequest: &quot;Hospice Care Ambulatory&quot;]).isInterventionOrder()) HospiceOrder\n        where HospiceOrder.authoredOn.toInterval() during day of &quot;Measurement Period&quot;\n        // and HospiceOrder.doNotPerform is not true\n        // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447\n    )\n    or exists ((([Procedure: &quot;Hospice Care Ambulatory&quot;]).isInterventionPerformed()) HospicePerformed\n        where HospicePerformed.performed.toInterval() overlaps day of &quot;Measurement Period&quot;\n    )\n    or exists (([Condition: &quot;Hospice Diagnosis&quot;]) HospiceCareDiagnosis\n        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of &quot;Measurement Period&quot;\n    )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>PrimaryCariesPreventionasOfferedbyDentistsFHIR</td>\n                            \n                            \n                                <td>Denominator Exclusions</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator Exclusions&quot;:\n  Hospice.&quot;Has Hospice Services&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>Status</td>\n                            \n                            \n                                <td>isProcedurePerformed</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Procedure, Performed\ndefine fluent function isProcedurePerformed(Proc List&lt;Procedure&gt;):\n  Proc P\n    where P.status ~ 'completed'</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>Status</td>\n                            \n                            \n                                <td>isEncounterPerformed</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List&lt;Encounter&gt;):\n  Enc E\n    where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommon</td>\n                            \n                            \n                                <td>toInterval</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval&lt;DateTime&gt;, or Interval&lt;Quantity&gt; types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval&lt;DateTime&gt; or Interval&lt;Quantity&gt;.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nIf 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\n*/\ndefine fluent function toInterval(choice Choice&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;, Timing&gt;):\n  case\n\t  when choice is DateTime then\n    \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval&lt;DateTime&gt; then\n  \t\tchoice as Interval&lt;DateTime&gt;\n\t\twhen choice is Quantity then\n\t\t  Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t  Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval&lt;Quantity&gt; then\n\t\t  Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t  Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\twhen choice is Timing then\n      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval&lt;DateTime&gt;\n\t\telse\n\t\t\tnull as Interval&lt;DateTime&gt;\n\tend</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>Status</td>\n                            \n                            \n                                <td>isAssessmentPerformed</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA.\n\n//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List&lt;Observation&gt;):\n  Obs O\n    where O.status in { 'final', 'amended', 'corrected' }\n          and exists ( O.category ObservationCategory\n          where ( ObservationCategory ) ~ &quot;survey&quot;\n      )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>FHIRHelpers</td>\n                            \n                            \n                                <td>ToConcept</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>Status</td>\n                            \n                            \n                                <td>isInterventionOrder</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Intervention, Order: active and completed only    \ndefine fluent function isInterventionOrder(ServiceRequest List&lt;ServiceRequest&gt;):\n  ServiceRequest S\n    where S.status in { 'active', 'completed' }\n      and S.intent = 'order'</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>Status</td>\n                            \n                            \n                                <td>isInterventionPerformed</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List&lt;Procedure&gt;):\n  Proc P\n    where P.status ~ 'completed'</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommon</td>\n                            \n                            \n                                <td>prevalenceInterval</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting \ninterval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ &quot;active&quot;\n  or condition.clinicalStatus ~ &quot;recurrence&quot;\n  or condition.clinicalStatus ~ &quot;relapse&quot; then\n  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n    (end of condition.abatementInterval()) abatementDate\n    return if abatementDate is null then\n      Interval[start of condition.onset.toInterval(), abatementDate)\n    else\n      Interval[start of condition.onset.toInterval(), abatementDate]</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                    </table>\n                </td>\n            </tr>\n            \n        \n    \n\n    </table>\n</div>"
  },
  "contained" : [
    {
      "resourceType" : "Library",
      "id" : "effective-data-requirements",
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding" : {
            "system" : "http://snomed.info/sct",
            "code" : "428361000124107",
            "display" : "Discharge to home for hospice care (procedure)"
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding" : {
            "system" : "http://snomed.info/sct",
            "code" : "428371000124100",
            "display" : "Discharge to healthcare facility for hospice care (procedure)"
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding" : {
            "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
            "code" : "survey",
            "display" : "survey"
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding" : {
            "system" : "http://snomed.info/sct",
            "code" : "373066001",
            "display" : "Yes (qualifier value)"
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding" : {
            "system" : "http://loinc.org",
            "code" : "45755-6",
            "display" : "Hospice care [Minimum Data Set]"
          }
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "PrimaryCariesPreventionasOfferedbyDentistsFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Numerator"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Numerator\":\n  Count((([Procedure: \"Fluoride Varnish Application for Children\"]).isProcedurePerformed()) FluorideApplication\n      where FluorideApplication.performed.toInterval() ends during day of \"Measurement Period\"\n      return distinct date from \n      end of FluorideApplication.performed.toInterval()\n  ) >= 2"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 0
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "PrimaryCariesPreventionasOfferedbyDentistsFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Stratification 3"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Stratification 3\":\n  AgeInYearsAt(date from start of \"Measurement Period\") in Interval[13, 20]"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 1
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "PrimaryCariesPreventionasOfferedbyDentistsFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Stratification 2"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Stratification 2\":\n  AgeInYearsAt(date from start of \"Measurement Period\") in Interval[6, 12]"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 2
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "PrimaryCariesPreventionasOfferedbyDentistsFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Stratification 1"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Stratification 1\":\n  AgeInYearsAt(date from start of \"Measurement Period\") in Interval[1, 5]"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 3
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "PrimaryCariesPreventionasOfferedbyDentistsFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Qualifying Encounters"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Qualifying Encounters\":\n  ( ( [Encounter: \"Clinical Oral Evaluation\"] ).isEncounterPerformed ( ) ) ValidEncounter\n    where ValidEncounter.period during day of \"Measurement Period\""
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 4
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "PrimaryCariesPreventionasOfferedbyDentistsFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Initial Population"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Initial Population\":\n  AgeInYearsAt(date from start of \"Measurement Period\") in Interval[1, 20]\n    and exists ( \"Qualifying Encounters\" )"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 5
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "PrimaryCariesPreventionasOfferedbyDentistsFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Denominator"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Denominator\":\n  \"Initial Population\""
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 6
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "Hospice"
            },
            {
              "url" : "name",
              "valueString" : "Has Hospice Services"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Has Hospice Services\":\n  exists ((([Encounter: \"Encounter Inpatient\"]).isEncounterPerformed()) InpatientEncounter\n      where (InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n          or InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"\n      )\n        and InpatientEncounter.period.toInterval() ends during day of \"Measurement Period\"\n  )\n    or exists ((([Encounter: \"Hospice Encounter\"]).isEncounterPerformed()) HospiceEncounter\n        where HospiceEncounter.period.toInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ((([Observation: \"Hospice care [Minimum Data Set]\"]).isAssessmentPerformed()) HospiceAssessment\n        where HospiceAssessment.value ~ \"Yes (qualifier value)\"\n          and HospiceAssessment.effective.toInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ((([ServiceRequest: \"Hospice Care Ambulatory\"]).isInterventionOrder()) HospiceOrder\n        where HospiceOrder.authoredOn.toInterval() during day of \"Measurement Period\"\n        // and HospiceOrder.doNotPerform is not true\n        // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447\n    )\n    or exists ((([Procedure: \"Hospice Care Ambulatory\"]).isInterventionPerformed()) HospicePerformed\n        where HospicePerformed.performed.toInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists (([Condition: \"Hospice Diagnosis\"]) HospiceCareDiagnosis\n        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n    )"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 7
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "PrimaryCariesPreventionasOfferedbyDentistsFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Denominator Exclusions"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Denominator Exclusions\":\n  Hospice.\"Has Hospice Services\""
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 8
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "Status"
            },
            {
              "url" : "name",
              "valueString" : "isProcedurePerformed"
            },
            {
              "url" : "statement",
              "valueString" : "//Procedure, Performed\ndefine fluent function isProcedurePerformed(Proc List<Procedure>):\n  Proc P\n    where P.status ~ 'completed'"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 9
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "Status"
            },
            {
              "url" : "name",
              "valueString" : "isEncounterPerformed"
            },
            {
              "url" : "statement",
              "valueString" : "//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List<Encounter>):\n  Enc E\n    where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 10
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "QICoreCommon"
            },
            {
              "url" : "name",
              "valueString" : "toInterval"
            },
            {
              "url" : "statement",
              "valueString" : "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nIf 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\n*/\ndefine fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):\n  case\n\t  when choice is DateTime then\n    \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval<DateTime> then\n  \t\tchoice as Interval<DateTime>\n\t\twhen choice is Quantity then\n\t\t  Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t  Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval<Quantity> then\n\t\t  Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t  Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\twhen choice is Timing then\n      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>\n\t\telse\n\t\t\tnull as Interval<DateTime>\n\tend"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 11
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "Status"
            },
            {
              "url" : "name",
              "valueString" : "isAssessmentPerformed"
            },
            {
              "url" : "statement",
              "valueString" : "//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA.\n\n//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List<Observation>):\n  Obs O\n    where O.status in { 'final', 'amended', 'corrected' }\n          and exists ( O.category ObservationCategory\n          where ( ObservationCategory ) ~ \"survey\"\n      )"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 12
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "FHIRHelpers"
            },
            {
              "url" : "name",
              "valueString" : "ToConcept"
            },
            {
              "url" : "statement",
              "valueString" : "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 13
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "Status"
            },
            {
              "url" : "name",
              "valueString" : "isInterventionOrder"
            },
            {
              "url" : "statement",
              "valueString" : "//Intervention, Order: active and completed only    \ndefine fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):\n  ServiceRequest S\n    where S.status in { 'active', 'completed' }\n      and S.intent = 'order'"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 14
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "Status"
            },
            {
              "url" : "name",
              "valueString" : "isInterventionPerformed"
            },
            {
              "url" : "statement",
              "valueString" : "//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List<Procedure>):\n  Proc P\n    where P.status ~ 'completed'"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 15
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "QICoreCommon"
            },
            {
              "url" : "name",
              "valueString" : "prevalenceInterval"
            },
            {
              "url" : "statement",
              "valueString" : "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting \ninterval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ \"active\"\n  or condition.clinicalStatus ~ \"recurrence\"\n  or condition.clinicalStatus ~ \"relapse\" then\n  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n    (end of condition.abatementInterval()) abatementDate\n    return if abatementDate is null then\n      Interval[start of condition.onset.toInterval(), abatementDate)\n    else\n      Interval[start of condition.onset.toInterval(), abatementDate]"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 16
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        }
      ],
      "name" : "EffectiveDataRequirements",
      "status" : "active",
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/library-type",
            "code" : "module-definition"
          }
        ]
      },
      "relatedArtifact" : [
        {
          "type" : "depends-on",
          "display" : "Library Status",
          "resource" : "Library/Status|1.8.000"
        },
        {
          "type" : "depends-on",
          "display" : "Library QICoreCommon",
          "resource" : "Library/QICoreCommon|2.1.000"
        },
        {
          "type" : "depends-on",
          "display" : "Library FHIRHelpers",
          "resource" : "Library/FHIRHelpers|4.4.000"
        },
        {
          "type" : "depends-on",
          "display" : "Library Hospice",
          "resource" : "Library/Hospice|6.12.000"
        },
        {
          "type" : "depends-on",
          "display" : "Code system SNOMEDCT",
          "resource" : "http://snomed.info/sct"
        },
        {
          "type" : "depends-on",
          "display" : "Code system ObservationCategoryCodes",
          "resource" : "http://terminology.hl7.org/CodeSystem/observation-category"
        },
        {
          "type" : "depends-on",
          "display" : "Code system LOINC",
          "resource" : "http://loinc.org"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Fluoride Varnish Application for Children",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.125.12.1002"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Clinical Oral Evaluation",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.125.12.1003"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Encounter Inpatient",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Hospice Encounter",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Hospice Care Ambulatory",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Hospice Diagnosis",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165"
        }
      ],
      "parameter" : [
        {
          "name" : "Measurement Period",
          "use" : "in",
          "min" : 0,
          "max" : "1",
          "type" : "Period"
        },
        {
          "name" : "Numerator",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "boolean"
        },
        {
          "name" : "Stratification 3",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "boolean"
        },
        {
          "name" : "Stratification 2",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "boolean"
        },
        {
          "name" : "Stratification 1",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "boolean"
        },
        {
          "name" : "Denominator",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "boolean"
        },
        {
          "name" : "Initial Population",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "boolean"
        },
        {
          "name" : "Denominator Exclusions",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "boolean"
        }
      ],
      "dataRequirement" : [
        {
          "type" : "Procedure",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport" : [
            "code",
            "performed",
            "status",
            "status.value"
          ],
          "codeFilter" : [
            {
              "path" : "code",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.125.12.1002"
            }
          ],
          "dateFilter" : [
            {
              "path" : "performed",
              "valuePeriod" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
                    "valueExpression" : {
                      "language" : "text/cql-identifier",
                      "expression" : "Measurement Period"
                    }
                  }
                ]
              }
            }
          ]
        },
        {
          "type" : "Procedure",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport" : [
            "code",
            "performed",
            "status",
            "status.value"
          ],
          "codeFilter" : [
            {
              "path" : "code",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"
            }
          ]
        },
        {
          "type" : "Patient",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ]
        },
        {
          "type" : "Encounter",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport" : [
            "type",
            "period",
            "status",
            "status.value"
          ],
          "codeFilter" : [
            {
              "path" : "type",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.125.12.1003"
            }
          ]
        },
        {
          "type" : "Encounter",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport" : [
            "type",
            "hospitalization",
            "hospitalization.dischargeDisposition",
            "period",
            "status",
            "status.value"
          ],
          "codeFilter" : [
            {
              "path" : "type",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
            }
          ]
        },
        {
          "type" : "Encounter",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport" : [
            "type",
            "period",
            "status",
            "status.value"
          ],
          "codeFilter" : [
            {
              "path" : "type",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"
            }
          ]
        },
        {
          "type" : "Observation",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"
          ],
          "mustSupport" : [
            "code",
            "value",
            "effective",
            "status",
            "status.value",
            "category"
          ],
          "codeFilter" : [
            {
              "path" : "code",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "45755-6",
                  "display" : "Hospice care [Minimum Data Set]"
                }
              ]
            },
            {
              "path" : "value"
            }
          ]
        },
        {
          "type" : "ServiceRequest",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"
          ],
          "mustSupport" : [
            "code",
            "authoredOn",
            "authoredOn.value",
            "status",
            "status.value",
            "intent",
            "intent.value"
          ],
          "codeFilter" : [
            {
              "path" : "code",
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            }
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        },
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            "code"
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            }
          ]
        }
      ]
    }
  ],
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem",
      "valueReference" : {
        "reference" : "Device/cqf-tooling"
      }
    },
    {
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      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
      "valueReference" : {
        "reference" : "#effective-data-requirements"
      }
    }
  ],
  "url" : "https://madie.cms.gov/Measure/PrimaryCariesPreventionasOfferedbyDentistsFHIR",
  "identifier" : [
    {
      "use" : "usual",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code" : "short-name"
          }
        ]
      },
      "system" : "https://madie.cms.gov/measure/shortName",
      "value" : "CMS74FHIR"
    },
    {
      "use" : "official",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code" : "version-independent"
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        ]
      },
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:uuid:1c99917f-438b-4cdb-ba95-d2fb32f9d715"
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      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:uuid:d28e85be-55aa-470f-8138-e13fa160159b"
    },
    {
      "use" : "official",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code" : "publisher"
          }
        ]
      },
      "system" : "https://madie.cms.gov/measure/cmsId",
      "value" : "74FHIR",
      "assigner" : {
        "display" : "CMS"
      }
    }
  ],
  "version" : "0.0.002",
  "name" : "PrimaryCariesPreventionasOfferedbyDentistsFHIR",
  "title" : "Primary Caries Prevention Intervention as Offered by DentistsFHIR",
  "status" : "draft",
  "experimental" : false,
  "date" : "2024-12-18T21:25:48+00:00",
  "publisher" : "Centers for Medicare & Medicaid Services (CMS)",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "https://www.cms.gov/"
        }
      ]
    }
  ],
  "description" : "Percentage of children, 1-20 years of age, who received two fluoride varnish applications during the measurement period as determined by a dentist",
  "purpose" : "UNKNOWN",
  "usage" : "This eCQM is a patient-based measure.\n\nTelehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible codes and requires a clinical action that cannot be conducted via telehealth.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS74v14.\n\nPlease refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
  "copyright" : "This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSP23320095627WC; HHSP23337008T) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications.\n\nLimited 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. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications.\n\nCPT(R) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use.\n\nThe American Dental Association (“ADA”) holds a copyright to the Current Dental Terminology (“CDT”) codes contained in certain measure specifications. The CDT codes in the measure specifications are included with the permission of the ADA. All uses of the CDT codes require a license from the ADA. No alteration, amendments, or modifications of the CDT or any portion thereof is allowed. Resale, transmission, or distribution of copies of the CDT or other portions of the CDT is also not allowed. To inquire about licensing, contact CDT-SNODENT@ada.org.\n\nThe measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use.\n\nThis material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. \n\nICD-10 copyright 2024 World Health Organization. All Rights Reserved.\n\n“HL7” is the registered trademark of Health Level Seven International.",
  "effectivePeriod" : {
    "start" : "2025-01-01",
    "end" : "2025-12-31"
  },
  "author" : [
    {
      "name" : "National Committee for Quality Assurance",
      "telecom" : [
        {
          "system" : "url",
          "value" : "https://www.ncqa.org/"
        }
      ]
    }
  ],
  "library" : [
    🔗 "https://madie.cms.gov/Library/PrimaryCariesPreventionasOfferedbyDentistsFHIR"
  ],
  "disclaimer" : "The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n \nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
  "scoring" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
        "code" : "proportion",
        "display" : "Proportion"
      }
    ]
  },
  "rationale" : "The literature reflects that fluoride varnish, when applied to the teeth of high-risk children, reduces, in conjunction with anticipatory guidance provided to the caregiver, the risk of the child developing caries (Weyant et al., 2013). Evidence in the literature also specifically supports the effectiveness of professionally applied fluoride varnish at preventing caries in higher risk children (Chou et al., 2014).",
  "clinicalRecommendationStatement" : "The 2013 American Dental Association (ADA) clinical recommendations for use of professionally applied or prescription-strength, home-use topical fluorides for caries prevention in patients at elevated risk of developing caries: \n\n- Younger Than 6 Years - 2.26 percent fluoride varnish at least every three to six months.\n\n- 6-18 Years - 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF*) gel for four minutes at least every three to six months.\n\n- Older Than 18 Years - 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF) gel for four minutes at least every three to six months (Weyant et al., 2013).\n\nThe United States Preventive Services Taskforce (USPSTF) recommends the use of professionally applied fluoride varnish for the prevention of dental caries in high risk children under 5 years of age (Chou et al., 2014).",
  "group" : [
    {
      "id" : "64e664622ad653247b573aea",
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          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
          "valueCodeableConcept" : {
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                "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                "code" : "proportion",
                "display" : "Proportion"
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        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
          "valueCode" : "boolean"
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-type",
                "code" : "process",
                "display" : "Process"
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          }
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode" : "None"
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept" : {
            "coding" : [
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                "system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code" : "decrease",
                "display" : "increase"
              }
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        }
      ],
      "population" : [
        {
          "id" : "7C6C9468-68A3-4176-AA4E-9D4784D8B4B9",
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "initial-population",
                "display" : "Initial Population"
              }
            ]
          },
          "description" : "Children, 1-20 years of age at the start of the measurement period, with a clinical oral evaluation by a dentist during the measurement period",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Initial Population"
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        },
        {
          "id" : "6EB256D2-EA24-428D-8B3D-BC6EC3E5BBC6",
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "denominator",
                "display" : "Denominator"
              }
            ]
          },
          "description" : "Equals Initial Population",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Denominator"
          }
        },
        {
          "id" : "F32AEDEB-CA39-4141-92BB-31033D2B3649",
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "denominator-exclusion",
                "display" : "Denominator Exclusion"
              }
            ]
          },
          "description" : "Exclude patients who are in hospice care for any part of the measurement period",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Denominator Exclusions"
          }
        },
        {
          "id" : "A9B3E783-D097-40D8-B4F3-D0795093AB3C",
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "numerator",
                "display" : "Numerator"
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            ]
          },
          "description" : "Children who receive two fluoride varnish applications on different days during the measurement period",
          "criteria" : {
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            "expression" : "Numerator"
          }
        }
      ],
      "stratifier" : [
        {
          "id" : "b4b470c5-adca-4b31-bd80-9717d6ebfe87",
          "extension" : [
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              "valueCodeableConcept" : {
                "coding" : [
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                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "initial-population",
                    "display" : "Initial Population"
                  }
                ]
              }
            }
          ],
          "description" : "Population 1: Patients age 1-5 years at the start of the Measurement Period  ",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Stratification 1"
          }
        },
        {
          "id" : "d7c07980-4cab-4f35-a00b-216b17f3f08c",
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              "valueCodeableConcept" : {
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                    "code" : "initial-population",
                    "display" : "Initial Population"
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          ],
          "description" : "Population 2: Patients age 6-12 years at the start of the Measurement Period ",
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            "expression" : "Stratification 2"
          }
        },
        {
          "id" : "d7a5caa5-6309-4572-b76a-e5c1ca50b0cb",
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                    "code" : "initial-population",
                    "display" : "Initial Population"
                  }
                ]
              }
            }
          ],
          "description" : "Population 3: Patients age 13-20 years at the start of the Measurement Period",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Stratification 3"
          }
        }
      ]
    }
  ]
}