For CMS 138, Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention, the intent of the denominator exception is that the limited life expectancy diagnosis overlaps after the Measurement Period. It means that, a limited life expectancy diagnosis can start either before the Measurement Period, during the Measurement Period, or at the same time as the end of the Measurement Period, but it must end after the end of the Measurement Period (or does not end at all – e.g., END DATE (NULL) to qualify as a valid exception. A diagnosis that ended concurrently with the end of the Measurement Period would not satisfy the ‘overlaps after’ timing requirement. For additional information about the use of the “overlaps after” and other timing operators, we recommend reviewing the CQL specifications and in particular, the following CQL reference: https://cql.hl7.org/09-b-cqlreference.html To obtain greater consistency in responses for future questions across sites, it would be helpful to limit the question to the area of primary concern or interest within the logic itself, instead of providing pieces of scenarios that may be prone to misinterpretation outside of the context of the full measure. For example, instead of asking whether the patient passes in the following scenarios, it might be better to ask about when the limited life expectancy diagnosis must be active to be considered a medical reason for not screening for tobacco usage. Then the focus of our responses could be on the relevant logic instead of testing cases, which may differ in other key parameters and result in different answers. We hope this helps with any future questions.