Brief Description of Measure:

​CMS122: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period

CMS131: Diabetes: Eye Exam

Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or in the 12 months prior to the measurement period

CMS134: Diabetes: Medical Attention for Nephropathy

The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period

Description of Issue:
​The measure guidance for CMS 122, CMS 131, and CMS 134 states the following:

"Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included."

However, the value sets used in the denominator of these measures allow for those diagnosis codes, as they align with the intent of the measures.

Proposed Solution:

Based on the intent of the measures, we propose to remove the following guidance statement from CMS 122, CMS 131, and CMS 134:

"Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included."

Rationale for Change:

This change is proposed to decrease confusion in the field and to align the guidance language with the intent of the measures.