Brief Description of Measure:

​CMS117: Childhood Immunization Status:
Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three or four H influenza type B (Hib); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday

Description of Issue:

​Based on confusion between the numerator header statement and our value sets relating to the seropositive test result criteria, we have decided to remove this criteria altogether from the measure. We are removing seropositive test results from the numerator criteria because it is not recommended by the CDC to conduct antibody testing in order to determine immunity to disease in lieu of vaccination. Removing this criteria will keep up in alignment with our HEDIS MY 2022 digital specification. ** 

Proposed Solution:

​The proposed solution is described below:

Current Valuesets:
•valueset "Anti Hepatitis A IgG Antigen Test" (2.16.840.1.113883.3.464.1003.198.12.1033)

•valueset "Anti Hepatitis B Virus Surface Ab" (2.16.840.1.113883.3.464.1003.198.12.1073) 

•valueset "Measles Antibody Test (IgG Antibody presence)" (2.16.840.1.113883.3.464.1003.198.12.1060)
•valueset "Measles Antibody Test (IgG Antibody Titer)" (2.16.840.1.113883.3.464.1003.198.12.1059) 

valueset "Positive Finding" (2.16.840.1.113883.3.464.1003.121.12.1016)

•valueset "Rubella Antibody Test (IgG Antibody presence)" (2.16.840.1.113883.3.464.1003.198.12.1064)
•valueset "Rubella Antibody Test (IgG Antibody Titer)" (2.16.840.1.113883.3.464.1003.198.12.1063) 

•valueset "Varicella Zoster Antibody Test (IgG Antibody Presence)" (2.16.840.1.113883.3.464.1003.198.12.1067)
•valueset "Varicella Zoster Antibody Test (IgG Antibody Titer)" (2.16.840.1.113883.3.464.1003.198.12.1066) 

Proposed Valuesets:

Remove all the valuesets listed above.

Current Numerator header language:
Children who have evidence showing they received recommended vaccines, had documented history of the illness, had a seropositive test result, or had an allergic reaction to the vaccine by their second birthday

Proposed header language:
DTaP
Children with any of the following on or before the child’s second birthday meet criteria:
•At least four DTaP vaccinations, with different dates of service. Do not count a vaccination administered prior to 42 days after birth.
•Anaphylaxis due to the diphtheria, tetanus or pertussis vaccine. 
•Encephalitis due to the diphtheria, tetanus or pertussis vaccine. 

IPV  
At least three IPV vaccinations, with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.

MMR
Children with either of the following meet criteria:
•At least one MMR vaccination on or between the child’s first and second birthdays.
•All of the following anytime on or before the child’s second birthday (on the same or different date of service):
oHistory of measles.
oHistory of mumps.
oHistory of rubella. 

HiB
Children with either of the following on or before the child’s second birthday meet criteria:
•At least three HiB vaccinations, with different dates of service. Do not count a vaccination administered prior to 42 days after birth.
•Anaphylaxis due to the HiB vaccine. 

Hepatitis B

Children with any of the following on or before the child’s second birthday meet criteria:
•At least three hepatitis B vaccinations, with different dates of service. 
oOne of the three vaccinations can be a newborn hepatitis B vaccination during the eight-day period that begins on the date of birth and ends seven days after the date of birth. For example, if the member’s date of birth is December 1, the newborn hepatitis B vaccination must be on or between December 1 and December 8.
•Anaphylaxis due to the hepatitis B vaccine.
•History of hepatitis B illness.

VZV
Children with either of the following meet criteria:
•At least one VZV vaccination, with a date of service on or between the child’s first and second birthdays.
•History of varicella zoster (e.g., chicken pox) illness on or before the child’s second birthday.

Pneumococcal Conjugate
At least four pneumococcal conjugate vaccinations, with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.

Hepatitis A
Children with either of the following meet criteria:
•At least one hepatitis A vaccination, with a date of service on or between the child’s first and second birthdays.
•History of hepatitis A illness on or before the child’s second birthday.

Rotavirus
Children with any of the following meet criteria:
•At least two doses of the two-dose rotavirus vaccine on different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.
•At least three doses of the three-dose rotavirus vaccine on different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.
•At least one dose of the two-dose rotavirus vaccine and at least two doses of the three-dose rotavirus vaccine, all on different dates of service, on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.
•Anaphylaxis due to the rotavirus vaccine on or before the child’s second birthday.

Influenza
At least two influenza vaccinations, with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 6 months (180 days) after birth.
•One of the two vaccinations can be an LAIV vaccination administered on the child’s second birthday. Do not count an LAIV vaccination administered before the child’s second birthday.

Current logic:
Hepatitis A Numerator Inclusion Conditions
( ( ["Laboratory Test, Performed": "Anti Hepatitis A IgG Antigen Test"] HepatitisAAntigenTest
    where HepatitisAAntigenTest.result as Code in "Positive Finding"
)
  union ( ["Diagnosis": "Adverse reaction to vaccine product containing Hepatitis A virus antigen (disorder)"] HepatitisAReaction
      return "Laboratory Test, Performed" { relevantDatetime: start of HepatitisAReaction.prevalencePeriod }
  )
  union ( ["Diagnosis": "Hepatitis A"] HepatitisADiagnosis
      return "Laboratory Test, Performed" { relevantDatetime: start of HepatitisADiagnosis.prevalencePeriod }
  ) ) HepatitisAConditions
  where Global."NormalizeInterval" ( HepatitisAConditions.relevantDatetime, HepatitisAConditions.relevantPeriod ) during "First Two Years"

Hepatitis B Numerator Inclusion Conditions
( ( ["Laboratory Test, Performed": "Anti Hepatitis B Virus Surface Ab"] HepatitisBAntigenTest
    where HepatitisBAntigenTest.result as Code in "Positive Finding"
)
  union ( ["Diagnosis": "Anaphylaxis due to Hepatitis B vaccine (disorder)"] HepatitisBReaction
      return "Laboratory Test, Performed" { relevantDatetime: start of HepatitisBReaction.prevalencePeriod }
  )
  union ( ["Diagnosis": "Anaphylactic Reaction to Common Baker's Yeast"] YeastReaction
      return "Laboratory Test, Performed" { relevantDatetime: start of YeastReaction.prevalencePeriod }
  )
  union ( ["Diagnosis": "Hepatitis B"] HepatitisBDiagnosis
      return "Laboratory Test, Performed" { relevantDatetime: start of HepatitisBDiagnosis.prevalencePeriod }
  ) ) HepBConditions
  where Global."NormalizeInterval" ( HepBConditions.relevantDatetime, HepBConditions.relevantPeriod ) ends during "First Two Years"

Measles Indicators
( ( ["Laboratory Test, Performed": "Measles Antibody Test (IgG Antibody Titer)"] MeaslesTiter
    where MeaslesTiter.result >= 1.10
)
  union ( ["Laboratory Test, Performed": "Measles Antibody Test (IgG Antibody presence)"] MeaslesIgGPresence
      where MeaslesIgGPresence.result as Code in "Positive Finding"
  )
  union ( ["Diagnosis": "Measles"] MeaslesDiagnosis
      return "Laboratory Test, Performed" { relevantDatetime: start of MeaslesDiagnosis.prevalencePeriod }
  ) ) Measles
  where Global."NormalizeInterval" ( Measles.relevantDatetime, Measles.relevantPeriod ) ends during "First Two Years"

Mumps Indicators
( ( ["Laboratory Test, Performed": "Mumps Antibody Test (IgG Antibody Titer)"] MumpsTiter
    where MumpsTiter.result >= 1.10
)
  union ( ["Laboratory Test, Performed": "Mumps Antibody Test (IgG Antibody presence)"] MumpsIgGPresence
      where MumpsIgGPresence.result as Code in "Positive Finding"
  )
  union ( ["Diagnosis": "Mumps"] MumpsDiagnosis
      return "Laboratory Test, Performed" { relevantDatetime: start of MumpsDiagnosis.prevalencePeriod }
  ) ) Mumps
  where Global."NormalizeInterval" ( Mumps.relevantDatetime, Mumps.relevantPeriod ) during "First Two Years"

Rubella Indicators
( ( ["Laboratory Test, Performed": "Rubella Antibody Test (IgG Antibody Titer)"] RubellaTiter
    where RubellaTiter.result >= 1.10
)
  union ( ["Laboratory Test, Performed": "Rubella Antibody Test (IgG Antibody presence)"] RubellaIgGPresence
      where RubellaIgGPresence.result as Code in "Positive Finding"
  )
  union ( ["Diagnosis": "Rubella"] RubellaDiagnosis
      return "Laboratory Test, Performed" { relevantDatetime: start of RubellaDiagnosis.prevalencePeriod }
  ) ) Rubella
  where Global."NormalizeInterval" ( Rubella.relevantDatetime, Rubella.relevantPeriod ) ends during "First Two Years"

Varicella Zoster Numerator Inclusion Conditions
( ( ["Laboratory Test, Performed": "Varicella Zoster Antibody Test (IgG Antibody Titer)"] ChickenPoxTiter
    where ChickenPoxTiter.result >= 1.10
)
  union ( ["Laboratory Test, Performed": "Varicella Zoster Antibody Test (IgG Antibody Presence)"] ChickenPoxIgGPresence
      where ChickenPoxIgGPresence.result as Code in "Positive Finding"
  )
  union ( ["Diagnosis": "Disorders of the Immune System"] ImmuneDisorder
      return "Laboratory Test, Performed" { relevantDatetime: start of ImmuneDisorder.prevalencePeriod }
  )
  union ( ["Diagnosis": "HIV"] HIV
      return "Laboratory Test, Performed" { relevantDatetime: start of HIV.prevalencePeriod }
  )
  union ( ["Diagnosis": "Malignant Neoplasm of Lymphatic and Hematopoietic Tissue"] LymphaticMalignantNeoplasm
      return "Laboratory Test, Performed" { relevantDatetime: start of LymphaticMalignantNeoplasm.prevalencePeriod }
  )
  union ( ["Diagnosis": "Neomycin adverse reaction (disorder)"] NeomycinReaction
      return "Laboratory Test, Performed" { relevantDatetime: start of NeomycinReaction.prevalencePeriod }
  )
  union ( ["Diagnosis": "Varicella Zoster"] VaricellaZoster
      return "Laboratory Test, Performed" { relevantDatetime: start of VaricellaZoster.prevalencePeriod }
  ) ) VaricellaZosterConditions
  where Global."NormalizeInterval" ( VaricellaZosterConditions.relevantDatetime, VaricellaZosterConditions.relevantPeriod ) ends during "First Two Years"

Proposed logic:
Hepatitis A Numerator Inclusion Conditions
 ["Diagnosis": "Hepatitis A"] HepatitisADiagnosis
      
  where start of HepatitisADiagnosis.prevalencePeriod during day of "First Two Years"

Hepatitis B Numerator Inclusion Conditions
( ["Diagnosis": "Anaphylaxis due to Hepatitis B vaccine (disorder)"] 
  
  union  ["Diagnosis": "Hepatitis B"] ) HepBConditions
  where start of HepBConditions.prevalencePeriod  during day of "First Two Years

Measles Indicators  
 ["Diagnosis": "Measles"] MeaslesDiagnosis      
where start of MeaslesDiagnosis.prevalencePeriod  during day of "First Two Years") 

Mumps Indicators  
   ["Diagnosis": "Mumps"] MumpsDiagnosis  
  where start of MumpsDiagnosis.prevalencePeriod during day of "First Two Years"

Rubella Indicators
 ( ["Diagnosis": "Rubella"] RubellaDiagnosis
  where start of RubellaDiagnosis.prevalencePeriod during day of "First Two Years"

Varicella Zoster Numerator Inclusion Conditions
["Diagnosis": "Varicella Zoster"] VaricellaZoster
  where start of VaricellaZoster.prevalencePeriod during day of "First Two Years"

 Rationale for Change:

The CDC does not specifically recommend conducting antibody testing to determine immunity to disease in lieu of vaccination. Therefore, we propose to remove seropositive test results from the numerator header and logic. This change is also in alignment with our HEDIS MY 2022 digital specification.