Multiple inquiries from stakeholders regarding the requirement of the depression screening to occur on the date of the eligible encounter indicate that many providers are conducting screenings prior to the eligible encounter via electronic health records and have indicated that the measure should provide the option for clinicians to conduct pre-screenings. Additionally, stakeholders have indicated that eligible encounters should be expanded to allow ancillary staff (i.e. nurses and social workers) to conduct the depression screening. Modify the eCQM format to allow the option of pre-screening up to 14 days prior to the date of the eligible encounter. Additionally, we propose expanding eligible encounters to allow for ancillary staff (i.e. nurses and social workers) to conduct the depression screening. Rationale: Stakeholder requests were presented to the clinical subject matter experts who indicated that a 14 day pre-screening is the most reasonable option, pointing out that the diagnostic criteria for depression in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition allows for a two-week window of symptom assessment. The proposed eligible encounters were recommended by clinical subject matter experts.

​Final Recommendations: Update the measure description and guidance to include the following language: Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the eligible encounter.   Update the guidance to include the following language:   A depression screen is completed on the date of the encounter or up to 14 days prior to the date of the encounter using an age appropriate standardized depression screening tool AND if positive, either additional evaluation for depression, suicide risk assessment, referral to a practitioner who is qualified to diagnose and treat depression, pharmacological interventions, or other interventions or follow-up for the diagnosis or treatment of depression is documented on the date of the positive screen.   Depression screening is required once per measurement period, not at all encounters; this is patient based and not an encounter based measure.   Screening Tools:  * The name of the age appropriate standardized depression screening tool utilized must be documented in the medical record  * The depression screening must be reviewed and addressed in the office of the provider, filing the code, on the date of the encounter. Positive pre-screening results indicating a patient is at high risk for self-harm should receive more urgent intervention as determined by the provider practice.  * The screening should occur during a qualified encounter or up to 14 days prior to the date of the qualifying encounter.  * Standardized depression screening tools should be normalized and validated for the age appropriate patient population in which they are used   Follow-Up Plan:   * The follow-up plan must be related to a positive depression screening, example: "Patient referred for psychiatric evaluation due to positive depression screening."   Examples of a follow-up plan include but are not limited to:   * Additional evaluation or assessment for depression such as psychiatric interview, psychiatric evaluation, or assessment for bipolar disorder * Completion of any Suicide Risk Assessment such as Beck Depression Inventory or Beck Hopelessness Scale * Referral to a practitioner or program for further evaluation for depression, for example, referral to a psychiatrist, psychologist, social worker, mental health counselor, or other mental health service such as family or group therapy, support group, depression management program, or other service for treatment of depression * Other interventions designed to treat depression such as psychotherapy, pharmacological interventions, or additional treatment options * Pharmacologic treatment for depression is often indicated during pregnancy and/or lactation. Review and discussion of the risks of untreated versus treated depression is advised. Consideration of each patient's prior disease and treatment history, along with the risk profiles for individual pharmacologic agents, is important when selecting pharmacologic therapy with the greatest likelihood of treatment effect.​   Add the following CPT encounter codes to the Depression Screening Encounter Codes value set (2.16.840.1.113883.3.600.1916): 99078: Physician or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting (e.g., prenatal, obesity, or diabetic instructions)   99401: Preventative medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes   99402: Preventative medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes   99403: Preventative medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes   99404: Preventative medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes