Thank you for your inquiry. As is noted in the Guidance field in the measure header for CMS135v7, to satisfy the measure, it must be reported for all heart failure patients at least once during the measurement period if seen in the outpatient setting. If the patient has an eligible inpatient discharge during the measurement period, as defined in the measure logic, it is expected to be reported at each hospital discharge. In the given scenario for Population Criteria 1, if a patient who meets the denominator criteria has two outpatient encounters during the measurement period and the patient has received the ARB therapy in both outpatient encounters, the patient will be reported only once for that reporting year.   In the given scenario for Population Criteria 2, if a patient who meets the denominator criteria has two inpatient discharges during the measurement period and the patient has received the prescription of ARB therapy in both inpatient discharges, the patient will be reported twice for that reporting year.   While this measure has two populations, the measure is intended to have one reporting rate. Please refer to the Rate Aggregation field in the measure header on how a single performance rate can be calculated for this measure.   We hope this helps clarify the intent of the measure.