Brief Description of Measure:
​CMS128: Anti-depressant Medication Management:
Percentage of patients 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. Two rates are reported.
a. Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks).
b. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).

Description of Issue:
​The Initial Population logic currently requires age 18 years or older relative to the start of measurement period, which does not meet the measure intent. Specifying that the individual is at least 18 years old relative to the intake period, rather than the measurement period, more accurately ensures that individual meets the measure’s age requirement when they started their medication. 
Therefore, the measure developer proposes updating the age criteria to age 18 or older as of the end of the Intake Period (April 30 of the measurement period).

Proposed Solution:
​Before

//Header: Initial Population
Patients 18 years of age and older who were dispensed antidepressant medications within 245 days (8 months) prior to the measurement period through the first 120 days (4 months) of the measurement period, and were diagnosed with major depression 60 days prior to, or 60 days after the dispensing event and had a visit 60 days prior to, or 60 days after the dispensing event

//Logic: Initial Population (Population Criteria 1 and 2)

define "Initial Population":
exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
    where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 18
)

After

//Header: Initial Population
Patients 18 years of age and older as of April 30 of the measurement period who were dispensed antidepressant medications within 245 days (8 months) prior to the measurement period through the first 120 days (4 months) of the measurement period, and were diagnosed with major depression 60 days prior to, or 60 days after the dispensing event and had a visit 60 days prior to, or 60 days after the dispensing event

//Logic: Initial Population (Population Criteria 1 and 2)

define "Initial Population":
  AgeInYearsAt(date from "April 30 of the Measurement Period")>= 18
    and "Has Initial Major Depression Diagnosis"
    and exists "Qualifying Encounters"

define "April 30 of the Measurement Period":
  DateTime((year from start of "Measurement Period"), 4, 30, 0, 0, 0, 0, 0)

Rationale for Change:
The goal of this change is to bring the measure's technical age requirements into alignment with the measure intent.