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 or up to two days after the date of the qualifying encounter Description of issue: ​The measure intends to allow a Denominator Exception for patients who refuse or decline depression screening. It is not intended to allow for a Denominator Exception for patient refusal of treatment or follow-up plan. However, the currently applied "Patient Declined" value set (OID: 2.16.840.1.113883.3.526.3.1582) includes concepts that would be applicable to refusing treatment or follow-up plan. To better align with the measure intent, the measure developer proposes replacing the "Patient Declined" value set with two direct reference codes (DRCs) to allow patients to refuse only the depression screening. Goal of review: Obtain technical feedback

Proposed solution: TERMINOLOGY SECTION CHANGES: Remove: "Patient Declined" value set (OID: 2.16.840.1.113883.3.526.3.1582) Add: "code "Screening declined (situation)" ("SNOMEDCT Code (31021000119100)") and "code "Depression screening declined (situation)" ("SNOMEDCT Code (720834000)"). CURRENT LOGIC: define "Medical or Patient Reason for Not Screening Adolescent for Depression" ["Assessment, Not Performed": "Adolescent depression screening assessment"] NoAdolescentScreen   [...]   where ( NoAdolescentScreen.negationRationale in "Patient Declined"       or NoAdolescentScreen.negationRationale in "Medical Reason" )   define "Medical or Patient Reason for Not Screening Adult for Depression" ["Assessment, Not Performed": "Adult depression screening assessment"] NoAdultScreen   [...]   where ( NoAdultScreen.negationRationale in "Patient Declined"       or NoAdultScreen.negationRationale in "Medical Reason" )   PROPOSED LOGIC: define "Medical or Patient Reason for Not Screening Adolescent for Depression" ["Assessment, Not Performed": "Adolescent depression screening assessment"] NoAdolescentScreen   [...]   where ( NoAdolescentScreen.negationRationale in ( NoAdolescentScreen.negationRationale ~ "Depression screening declined (situation)"       or NoAdolescentScreen.negationRationale ~ "Screening declined (situation)"       or NoAdolescentScreen.negationRationale in "Medical Reason" )    define "Medical or Patient Reason for Not Screening Adult for Depression" ["Assessment, Not Performed": "Adult depression screening assessment"] NoAdultScreen   [...]   where ( NoAdultScreen.negationRationale in ( NoAdolescentScreen.negationRationale ~ "Depression screening declined (situation)"       or NoAdultScreen.negationRationale ~ "Screening declined (situation)"       or NoAdultScreen.negationRationale in "Medical Reason" ) Rationale for change: The measure intends to limit patient refusal in the denominator exception to refusal/decline of the depression screening only; revisions to the applied coding will align the logic with the measure intent.