​​The measure development team thanks you for your questions related to CMS986 Global Malnutrition Composite Score. In response to question #1, the terms of "Malnutrition Assessment" and "Nutrition Assessment" do refer to the same concept. In the next annual update, the measure will update the content and only use the term "Nutrition Assessment". In response to question #2 regarding the "Measure Observation TotalMalnutritionComponentsScore" (what you named "Obs 5"), the measure specification calculates performance per-episode, rather than patient. The "Measure Observation TotalMalnutritionComponentsScore" is the sum of the four (4) clinically eligible measure observations (i.e., activities performed) for each episode, which will be either 0, 1, 2, 3, or 4. Regarding the "Measure Observation TotalMalnutritionComponentsScore as Percentage" (what you named "Obs 6"), each episode (i.e., hospitalizations for patients => 65 years with a length of stay => 24 hours) will have up to four (4) 1-point Measure Observations completed during an episode, depending on clinical eligibility. If an episode meets the Measure Population Criteria, they are eligible for a screening (i.e., Measure Observation 1). If the screening determined "low risk" for malnutrition, the episode would not be clinically eligible for Measure Observations 2, 3, and 4. The "Measure Observation TotalMalnutritionComponentsScore as Percentage" calculates the summed Measure Observations that were performed divided by how many should have been performed based on the patient's clinical eligibility, all multiplied by 100 to give the percentage. Assuming this episode meets the age and timing criteria stated above, one (1) point would be given for Measure Observation 1. With a "low risk" screening result, the patient would not be eligible for Measures Observations 2, 3, and 4. The performance for this episode example would be 1 / 1 = 1 or 100%. The second part of this question appears to refer to the aggregation for population of hospitalizations. If there were 117 hospitalizations that were eligible for screening, and the 117 episodes were screened and found to be at "low risk" for malnutrition, then for "Measure Observation TotalMalnutritionComponentsScore as Percentage" (what you named "Obs 6"), would have an aggregated calculation of 117 /117 = 1 or 100%. If one (1) of 118 eligible episodes was found "at risk" for malnutrition, and no other Measure Observations were completed, the episode receives 1 of 4 clinically eligible Measure Observation points, and the aggregated performance would be 118 / 121 = 0.9752 or 97.52%. There are four (4) eligible denominators for episodes found "at risk" with no other Measure Observations performed. Regarding the clinical intent of observation 6, the "Measure Observation TotalMalnutritionComponentsScore as Percentage" (what you named "Obs 6") calculates the "Measure Observation TotalMalnutritionComponentsScore" (what you named "Obs 5") / "TotalMalnutritionComponentsScore Eligible Denominators" (what you might call "Obs 7") multiplied by 100 to provide the percentage. For the intent, this function calculates the percentage of clinically eligible Global Malnutrition Measure Observations performed for hospitalizations with patients that meet the Measure Population Criteria. The intent of the "TotalMalnutritionComponentsScore Eligible Denominators" is the number of Measure Observations that should have been performed for the hospitalization episode based on clinical eligibility.