BCSEHEDISMY2022.json

{
  "resourceType": "Measure",
  "id": "BCSEHEDISMY2022",
  "meta": {
    "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm", "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm" ]
  },
  "language": "en",
  "contained": [ {
    "resourceType": "Library",
    "id": "effective-data-requirements",
    "extension": [ {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
      "valueCoding": {
        "system": "http://terminology.hl7.org/ValueSet/v3-ActCoverageTypeCode",
        "code": "MCPOL"
      }
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
      "valueCoding": {
        "system": "http://terminology.hl7.org/ValueSet/v3-ActCoverageTypeCode",
        "code": "RETIRE"
      }
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
      "valueCoding": {
        "system": "http://terminology.hl7.org/ValueSet/v3-ActCoverageTypeCode",
        "code": "SUBSIDIZ"
      }
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "BCSEHEDISMY2022"
      }, {
        "url": "name",
        "valueString": "October 1 Two Years Prior to the Measurement Period"
      }, {
        "url": "statement",
        "valueString": "define \"October 1 Two Years Prior to the Measurement Period\":\n  DateTime((year from start of \"Measurement Period\" - 2), 10, 1, 0, 0, 0, 0, 0)"
      }, {
        "url": "displaySequence",
        "valueInteger": 0
      } ]
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "BCSEHEDISMY2022"
      }, {
        "url": "name",
        "valueString": "Participation Period"
      }, {
        "url": "statement",
        "valueString": "define \"Participation Period\":\n  Interval[\"October 1 Two Years Prior to the Measurement Period\",\n  end of \"Measurement Period\"]"
      }, {
        "url": "displaySequence",
        "valueInteger": 1
      } ]
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "BCSEHEDISMY2022"
      }, {
        "url": "name",
        "valueString": "Numerator"
      }, {
        "url": "statement",
        "valueString": "define \"Numerator\":\n  exists ( [Observation: \"Mammography\"] Mammogram\n      where FHIRBase.\"Normalize Interval\" ( Mammogram.effective ) ends during \"Participation Period\"\n  )"
      }, {
        "url": "displaySequence",
        "valueInteger": 2
      } ]
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "BCSEHEDISMY2022"
      }, {
        "url": "name",
        "valueString": "Member Coverage"
      }, {
        "url": "statement",
        "valueString": "define \"Member Coverage\":\n  [Coverage] C\n    where FHIRBase.\"Normalize Interval\" ( C.period ) overlaps \"Participation Period\""
      }, {
        "url": "displaySequence",
        "valueInteger": 3
      } ]
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "BCSEHEDISMY2022"
      }, {
        "url": "name",
        "valueString": "Enrolled During Participation Period"
      }, {
        "url": "statement",
        "valueString": "define \"Enrolled During Participation Period\":\n  Enrollment.\"Health Plan Enrollment Criteria\" ( \"Member Coverage\", date from\n  end of \"Measurement Period\", Interval[date from \"October 1 Two Years Prior to the Measurement Period\", date from\n  end of \"Measurement Period\" - 2 years], 0 )\n    and Enrollment.\"Health Plan Enrollment Criteria\" ( \"Member Coverage\", date from\n    end of \"Measurement Period\", Interval[date from start of \"Measurement Period\" - 1 year, date from\n    end of \"Measurement Period\" - 1 year], 45 )\n    and Enrollment.\"Health Plan Enrollment Criteria\" ( \"Member Coverage\", date from\n    end of \"Measurement Period\", Interval[date from start of \"Measurement Period\", date from\n    end of \"Measurement Period\"], 45 )"
      }, {
        "url": "displaySequence",
        "valueInteger": 4
      } ]
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "BCSEHEDISMY2022"
      }, {
        "url": "name",
        "valueString": "Initial Population"
      }, {
        "url": "statement",
        "valueString": "define \"Initial Population\":\n  AgeInYearsAt(date from\n    end of \"Measurement Period\"\n  )in Interval[52, 74]\n    and Patient.gender.value = 'female'\n    and \"Enrolled During Participation Period\""
      }, {
        "url": "displaySequence",
        "valueInteger": 5
      } ]
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "BCSEHEDISMY2022"
      }, {
        "url": "name",
        "valueString": "Denominator"
      }, {
        "url": "statement",
        "valueString": "define \"Denominator\":\n  \"Initial Population\""
      }, {
        "url": "displaySequence",
        "valueInteger": 6
      } ]
    } ],
    "status": "active",
    "type": {
      "coding": [ {
        "system": "http://terminology.hl7.org/CodeSystem/library-type",
        "code": "module-definition"
      } ]
    },
    "relatedArtifact": [ {
      "type": "depends-on",
      "display": "Library FHIRBase",
      "resource": "http://ecqi.healthit.gov/ecqms/Library/NCQAFHIRBase|1.0.0"
    }, {
      "type": "depends-on",
      "display": "Library Enrollment",
      "resource": "http://ecqi.healthit.gov/ecqms/Library/NCQAHealthPlanEnrollment|1.0.0"
    }, {
      "type": "depends-on",
      "display": "Library CQLBase",
      "resource": "http://ecqi.healthit.gov/ecqms/Library/NCQACQLBase|1.0.0"
    }, {
      "type": "depends-on",
      "display": "Library FHIRHelpers",
      "resource": "http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers|4.0.001"
    }, {
      "type": "depends-on",
      "display": "Library Terminology",
      "resource": "http://ecqi.healthit.gov/ecqms/Library/NCQATerminology|1.0.0"
    }, {
      "type": "depends-on",
      "display": "Code system coverage-type",
      "resource": "http://terminology.hl7.org/ValueSet/v3-ActCoverageTypeCode"
    }, {
      "type": "depends-on",
      "display": "Value set Mammography",
      "resource": "https://www.ncqa.org/fhir/valueset/2.16.840.1.113883.3.464.1004.1168"
    } ],
    "parameter": [ {
      "name": "Measurement Period",
      "use": "in",
      "min": 0,
      "max": "1",
      "type": "Period"
    }, {
      "name": "Numerator",
      "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"
    } ],
    "dataRequirement": [ {
      "type": "Observation",
      "profile": [ "http://hl7.org/fhir/StructureDefinition/Observation" ],
      "mustSupport": [ "code", "effective" ],
      "codeFilter": [ {
        "path": "code",
        "valueSet": "https://www.ncqa.org/fhir/valueset/2.16.840.1.113883.3.464.1004.1168"
      } ]
    }, {
      "type": "Patient",
      "profile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ]
    }, {
      "type": "Coverage",
      "profile": [ "http://hl7.org/fhir/StructureDefinition/Coverage" ],
      "mustSupport": [ "period" ]
    } ]
  } ],
  "extension": [ {
    "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
    "valueCode": "boolean"
  }, {
    "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem",
    "valueReference": {
      "reference": "Device/cqf-tooling"
    }
  }, {
    "id": "effective-data-requirements",
    "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
    "valueReference": {
      "reference": "#effective-data-requirements"
    }
  } ],
  "url": "http://ecqi.healthit.gov/ecqms/Measure/BCSEHEDISMY2022",
  "identifier": [ {
    "use": "official",
    "system": "http://ncqa.org/fhir/hedis",
    "value": "BCS-E"
  } ],
  "version": "MY2022",
  "name": "BCSEHEDISMY2022",
  "title": "Breast Cancer Screening",
  "status": "draft",
  "experimental": false,
  "date": "2022-07-05T20:34:35-06:00",
  "publisher": "National Committee for Quality Assurance",
  "contact": [ {
    "telecom": [ {
      "system": "url",
      "value": "https://ncqa.org"
    } ]
  } ],
  "description": "The percentage of women 50–74 years of age who had a mammogram to screen for breast cancer.",
  "purpose": "To support quality improvement initatives by providing computable representation of a quality measure that determines percentage of women that has appropriate screening for breast cancer.",
  "copyright": "<p>HEDIS® is a registered trademark of the National Committee for Quality Assurance (“NCQA”). The HEDIS measures and specifications were developed by and are owned by NCQA. NCQA holds a copyright in these materials and may rescind or alter these materials at any time. Users of the HEDIS measures and specifications shall not have the right to alter, enhance or otherwise modify the HEDIS measures and specifications, and shall not disassemble, recompile or reverse engineer the HEDIS measures and specifications. Anyone desiring to use or reproduce the materials, subject to licensed user restrictions, without modification for an internal non-commercial purpose may do so without obtaining any approval from NCQA. Use of the Rules for Allowable Adjustments of HEDIS to make permitted adjustments of the materials does not constitute a modification. All other uses, including a commercial use (including but not limited to vendors using the measures and specifications with a product or service to calculate measure results), or any external reproduction, distribution and publication of the HEDIS measures or results (“rates”) therefrom must be approved by NCQA and are subject to a license at the discretion of NCQA. Any use of the materials to identify records or calculate measure results, for example, requires a custom license and may necessitate certification pursuant to NCQA’s Measure Certification Program.</p><p>HEDIS measures and specifications are not clinical guidelines, do not establish a standard of medical care and have not been tested for all potential applications. The measures and specifications are provided “as is” without warranty of any kind. NCQA makes no representations, warranties or endorsements about the quality of any product, test or protocol identified as numerator compliant or otherwise identified as meeting the requirements of a HEDIS measure or specification. NCQA also makes no representations, warranties or endorsements about the quality of any organization or clinician who uses or reports performance measures. NCQA has no liability to anyone who relies on HEDIS measures and specifications or data reflective of performance under such measures and specifications.</p><p>Unadjusted Uncertified Measures: A calculated measure result (a “rate”) from a HEDIS measure that has not been certified via NCQA’s Measure Certification Program, and is based on unadjusted HEDIS specifications, may not be called a “Health Plan HEDIS rate” until it is audited and designated reportable by an NCQA-Certified HEDIS Compliance Auditor. Until such time, such measure rates shall be designated or referred to as “Uncertified, Unaudited Health Plan HEDIS Rates.”</p><p>Adjusted Uncertified Measures: A calculated measure result (a “rate”) from a HEDIS measure that has not been certified via NCQA’s Measure Certification Program, and is based on adjusted HEDIS specifications, may not be called an “Adjusted HEDIS rate” until it is audited and designated reportable by an NCQA-Certified HEDIS Compliance Auditor. Until such time, such measure rates shall be designated or referred to as “Adjusted, Uncertified, Unaudited HEDIS Rates.”</p><p>Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. NCQA disclaims all liability for use or accuracy of any coding contained in the specifications.</p><p>The American Medical Association holds a copyright to the CPT® codes contained in the measure specifications.</p><p>The American Hospital Association holds a copyright to the Uniform Billing Codes (“UB”) contained in the measure specifications. The UB Codes in the HEDIS specifications are included with the permission of the AHA. All uses of the UB Codes may require a license from the AHA. Anyone desiring to use the UB Codes in a commercial product to generate HEDIS results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact ub04@aha.org.</p><p>Some measure specifications contain coding from LOINC® (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 © 1995–2021 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><p>“SNOMED” and “SNOMED CT” are registered trademarks of the International Health Terminology Standards Development Organisation (IHTSDO).</p><p>“HL7” is the registered trademark of Health Level Seven International.</p><p>No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording or any information storage and retrieval system, without the written permission of NCQA.</p><p>© 2021 by the National Committee for Quality Assurance<br/>1100 13th Street, NW, Third Floor<br/>Washington, DC 20005</p><p>All rights reserved.</p><p>NCQA Customer Support: 888-275-7585<br/>NCQA Fax: 202-955-3599<br/>NCQA Website: www.ncqa.org</p><p>Submit policy clarification support questions via My NCQA (http://my.ncqa.org)</p>",
  "effectivePeriod": {
    "start": "2022-01-01",
    "end": "2022-12-31"
  },
  "library": [ "http://ecqi.healthit.gov/ecqms/Library/BCSEHEDISMY2022" ],
  "scoring": {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
      "code": "proportion",
      "display": "Proportion"
    } ]
  },
  "type": [ {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/measure-type",
      "code": "process"
    } ]
  } ],
  "riskAdjustment": "None",
  "clinicalRecommendationStatement": "The U.S. Preventive Services Task Force recommends screening women 50–74 years of age for breast cancer every 2 years. (B recommendation)",
  "improvementNotation": {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
      "code": "increase",
      "display": "A higher rate indicates better performance"
    } ]
  },
  "definition": [ "**Participation:** The identifiers and descriptors for each organization’s coverage used to define members’ eligibility for measure reporting. Allocation for reporting is based on eligibility during the Participation Period.", "**Participation Period:** October 1 two years prior to the Measurement Period through the end of the Measurement Period." ],
  "guidance": "* For Medicare plans, I-SNP and LTI exclusions are not included in the measure calculation logic and need to be programmed manually. Administrative data must be used for these exclusions.\n*Non-administrative data may be used for the frailty and advanced illness exclusion.\n<p>**Allocation:**<br/>The member was enrolled with a medical benefit throughout the Participation Period.</p><p>No more than one gap in enrollment of up to 45 days for each full calendar year of the Participation Period (i.e., the Measurement Period and the year prior to the Measurement Period).</p><p>No gaps in enrollment are allowed from October 1 two years prior to the Measurement Period through December 31 two years prior to the Measurement Period.</p><p>**Reporting:**<br/>For Medicare plans, the SES stratifications are mutually exclusive. NCQA calculates a total rate for Medicare plans by adding all six Medicare stratifications.</p><p>SES and product line stratifications are not included in the measure calculation logic and need to be programmed manually.</p><p>**Stratification:**<br/>1. Commercial.\n2. Medicaid.\n3. Medicare: Non-LIS/DE, Nondisability.\n4. Medicare: LIS/DE.\n5. Medicare: Disability\n6. Medicare: LIS/DE and Disability.\n7. Medicare: Other.\n8. Medicare: Unknown.</p>",
  "group": [ {
    "population": [ {
      "code": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "code": "initial-population",
          "display": "Initial Population"
        } ]
      },
      "description": "Women 52–74 years of age by the end of the Measurement Period who also meet the criteria for Participation.",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Initial Population"
      }
    }, {
      "code": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "code": "denominator",
          "display": "Denominator"
        } ]
      },
      "description": "The Initial Population, minus Exclusions.",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Denominator"
      }
    }, {
      "code": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "code": "denominator-exclusion",
          "display": "Denominator Exclusion"
        } ]
      },
      "description": "* Members in hospice or using hospice services any time during the Measurement Period.\n* Members who had a bilateral mastectomy or both right and left unilateral mastectomies any time during the member’s history through the end of the Measurement Period.\n* Medicare members 66 years of age and older by the end of the Measurement Period who meet either of the following:\n    * Enrolled in an Institutional SNP (I-SNP) any time during the Measurement Period.\n    * Living long-term in an institution any time during the Measurement Period, as identified by the LTI flag in the Monthly Membership Detail Data File. Use the run date of the file to determine if a member had an LTI flag during the Measurement Period.\n* Members 66 years of age and older by the end of the Measurement Period, with frailty and advanced illness.\n* Members receiving palliative care during the Measurement Period.",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Denominator Exclusions"
      }
    }, {
      "code": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "code": "numerator",
          "display": "Numerator"
        } ]
      },
      "description": "One or more mammograms any time on or between October 1 two years prior to the Measurement Period and the end of the Measurement Period.",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Numerator"
      }
    } ]
  } ]
}