CMS issued updated specs in May 2020 for the Hybrid HQR (CMS529-v1.3).

In this eCQM, there is reference to a new QDM called - "Participation: Medicare payer" using "Medicare payer (2.16.840.1.113762.1.4.1104.10)".

This is essentially capturing the same information as "Patient Characteristic: Payer" (but with codes on Medicare value set).

"Patient Characteristic: Payer" has been removed from this measure which is collected in every other measure.

We would appreciate if you can help us understand why this switch is being made for this measure only. Why are we not able to use "Patient Characteristic: Payer" with codes defined on the Medicare Payer value set?

I have provided additional information in the attached word document for reference.

Additionally, in the QRDA CAT I specs (Release 1, STU Release 5.2) - Feb 2020, for Program Participation (templateID: 2.16.840.1.113883.10.20.24.3.154), the codes for <value> shall be from the HL7ActCoverageType value set. On reviewing the HL7ActCoverageType value set (https://www.hl7.org/fhir/v3/ActCoverageTypeCode/vs.html) I do not see any codes in it that are included in the value set "Medicare Payer" (value set OID: 2.16.840.1.113762.1.4.1104.10) used in this measure. I'm wondering if it would be appropriate to use the codes from the "Medicare Payer" (value set OID: 2.16.840.1.113762.1.4.1104.10) with Program Participation.

Thanks in advance for your review and feedback.