CMS 128 0105 Anti-depressant Medication Management has an IPP node that reads as follows:

OR: "Occurrence A of Diagnosis, Active: Major Depression" <= 90 day(s) starts after start of "Measurement Period"
OR: "Occurrence A of Diagnosis, Active: Major Depression" <= 270 day(s) starts before start of "Measurement Period"

If the diagnosis occurs at the exact moment of the start of the measurement period then it is not counted. But if it happens one second earlier or later then it is counted. This situation can occur for example when the diagnosis only includes a date value with no time part. It is common for diagnoses to not include a time element.

Is it the intent of the measure to not include diagnoses that occur precisely at the start of the measurement period or on the same day as the mp start? Is this a known limitation of the measure or data model, and is there guidance for handling these cases?

I can see this logic occurs in CMS128v2 as well as CMS128v3. I assume this type of problem occurs in other measures as well.