Brief Description of Measure:
​CMS147: Preventive Care and Screening: Influenza Immunization:
Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization
 
Description of Issue:
For the 2021-2022 flu season, the Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for everyone 6 months and older with any licensed, influenza vaccine that is appropriate for the recipient’s age and health status, including inactivated influenza vaccine (IIV4), recombinant influenza vaccine (RIV4), or live attenuated nasal spray influenza vaccine (LAIV4) with no preference expressed for any one vaccine over another. 
 
Therefore, the measure developer proposes adding receipt of the LAIV during the influenza season to the numerator to align with the updated clinical guidelines. The paragraph about the LAIV will be removed from the guidance to align with this change. 

Proposed Solution:
//Current clinical recommendation statement:
Routine annual influenza vaccination is recommended for all persons aged >= 6 months who do not have contraindications. Optimally, vaccination should occur before onset of influenza activity in the community. Although vaccination by the end of October is recommended, vaccine administered in December or later, even if influenza activity has already begun, is likely to be beneficial in the majority of influenza seasons (CDC/Advisory Committee on Immunization Practices [ACIP], 2020).

//Proposed clinical recommendation statement:
Routine annual influenza vaccination is recommended for all persons aged >= 6 months who do not have contraindications. For each recipient, a licensed and age-appropriate vaccine should be used. ACIP makes no preferential recommendation for a specific vaccine when more than one licensed, recommended, and age-appropriate vaccine is available. During the 2021–22 influenza season, the following types of vaccines are expected to be available: inactivated influenza vaccines (IIV4s), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4) (CDC/Advisory Committee on Immunization Practices [ACIP], 2021). 

//Current guidance header language:
.............Due to the changing stance of the CDC/ACIP recommendations regarding the live attenuated influenza vaccine (LAIV) for a particular flu season, this measure will not include the administration of this specific formulation of the flu vaccination. Given the variance of the timeframes for the annual update cycles, program implementation, and publication of revised recommendations from the CDC/ACIP, it has been determined that the coding for this measure will specifically exclude this formulation, so as not to inappropriately include this form of the vaccine for flu seasons when CDC/ACIP explicitly advise against it. However, it is recommended that all eligible professionals or eligible clinicians to review the guidelines for each flu season to determine appropriateness of the LAIV and other formulations of the flu vaccine. Should the LAIV be recommended for administration for a particular flu season, eligible professional or clinician may consider one of the following options: 1) satisfy the numerator by reporting either previous receipt or using the CVX 88 for unspecified formulation, 2) report a denominator exception, either as a patient reason (e.g., for patient preference) or a system reason (e.g., the institution only carries LAIV)....

//Proposed guidance header language:
.......Remove the entire paragraph above......
//Add two value sets:
   - Influenza Virus LAIV Immunization - 2.16.840.1.113883.3.464.1003.110.12.1087
   - Influenza Virus LAIV Procedure - 2.16.840.1.113883.3.464.1003.110.12.1088
 
//Current Numerator definitions:
Influenza Immunization Administered
["Immunization, Administered": "Influenza Vaccine"] AdministeredFluVaccine
  where AdministeredFluVaccine.relevantDatetime during "Influenza Season Including August and September of the Prior Year"
 
Influenza Vaccination Procedure
["Procedure, Performed": "Influenza Vaccination"] FluVaccination
  where Global."NormalizeInterval" ( FluVaccination.relevantDatetime, FluVaccination.relevantPeriod ) during "Influenza Season Including August and September of the Prior Year"
 
//Proposed updates to the Numerator definitions:
Influenza Immunization Administered
["Immunization, Administered": "Influenza Vaccine"]
union ["Immunization, Administered": “Influenza Virus LAIV Immunization”] AdministeredFluVaccine
  where AdministeredFluVaccine.relevantDatetime during "Influenza Season Including August and September of the Prior Year"
 
Influenza Vaccination Procedure
["Procedure, Performed": "Influenza Vaccination"]
union ["Procedure, Performed": "Influenza Virus LAIV Procedure"] FluVaccination
  where Global."NormalizeInterval" ( FluVaccination.relevantDatetime, FluVaccination.relevantPeriod ) during "Influenza Season Including August and September of the Prior Year"

Rationale for Change:
The Centers for Disease Control (CDC) and Advisory Committee on Immunization Practices (ACIP) now recommends annual influenza (flu) vaccination for everyone 6 months and older with any licensed, influenza vaccine that is appropriate for the recipient’s age and health status, including inactivated influenza vaccine (IIV4), recombinant influenza vaccine (RIV4), or live attenuated nasal spray influenza vaccine (LAIV4) with no preference expressed for any one vaccine over another.