Brief Description of Measure:

​CMS2: Preventive Care and Screening: Screening for Depression and Follow-Up Plan:
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

Description of Issue:

​The measure currently excludes patients who have had a diagnosis of depression or bipolar disorder.
Several stakeholders have raised questions about the timing of the denominator exclusions and have received conflicting guidance about when a patient should be excluded. Additionally, the measure guidance does not specify if a patient should be excluded if a diagnosis of depression or bipolar disorder is documented as ending before the qualifying encounter used to evaluate the measure numerator, which has caused confusion.
The measure intent is for patients who have EVER been diagnosed with depression or bipolar disorder to be excluded from the measure. Therefore, upon consultation with the expert work group, they suggested language changes to the guidance and denominator exclusion fields to emphasize the measure intent and clarify guidance around when a patient should be excluded.

Proposed Solution: 

Current Language:
Guidance: The intent of the measure is to screen for depression in patients who have never had a diagnosis of depression or bipolar disorder prior to the eligible encounter used to evaluate the numerator. Patients who have ever been diagnosed with depression or bipolar disorder will be excluded from the measure. 
Denominator exclusion: Patients who have ever been diagnosed with depression or with bipolar disorder
 
Proposed New Language:
Guidance: The intent of the measure is to screen for new cases of depression in patients who have never had a diagnosis of depression or bipolar disorder. Patients who have ever been diagnosed with depression or bipolar disorder prior to the qualifying encounter used to evaluate the numerator will be excluded from the measure regardless of whether the diagnosis is active or not.
Denominator exclusion: Patients who have ever been diagnosed with depression or with bipolar disorder at any time prior to the qualifying encounter

Rationale for Change:

Revising the guidance and denominator exclusion language will improve alignment with measure intent and clarify the timing requirements of diagnoses for the measure exclusions.