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 The Measure Developer received feedback that the way the logic is currently specified does not accurately capture the hepatitis B vaccine series (total of 3 vaccines) in which one of the vaccines can be a newborn vaccine during the 8 day period after birth. We are updating the logic to ensure that, for this option, 2 hepatitis B vaccines (the non-newborn vaccines) can be given anytime between birth and the 2nd birthday, and that the newborn vaccines must be given in the first 8 days after birth. Goal of review Obtain technical feedback

Proposed solution ​//Numerator, Definitions, and Terminology before:   define "Numerator" [...]   and ( exists ( "Three Hepatitis B Vaccinations" )       or ( exists ( "Meets HepB Vaccination Requirement" )           or exists ( "Hepatitis B Numerator Inclusion Conditions" ) [...]   define "Three Hepatitis B Vaccinations":   from     "Hepatitis B Immunizations or Procedures" HepatitisBVaccination1,     "Hepatitis B Immunizations or Procedures" HepatitisBVaccination2,     "Hepatitis B Immunizations or Procedures" HepatitisBVaccination3     where HepatitisBVaccination2.relevantDatetime 1 day or more after day of HepatitisBVaccination1.relevantDatetime       and HepatitisBVaccination3.relevantDatetime 1 day or more after day of HepatitisBVaccination2.relevantDatetime     return HepatitisBVaccination1   define “Meets HepB Vaccination Requirement”” "Three Hepatitis B Vaccinations" HepatitisBRequirement   where date from HepatitisBRequirement.relevantDatetime during day of Interval[Patient.birthDatetime, Patient.birthDatetime + 7 days]   "Hepatitis B Vaccine Administered" value set OID 2.16.840.1.113883.3.464.1003.110.12.1042  //ICD10 code 3E0234Z    Numerator, Definitions, and Terminolgy after:   define "Numerator" [...]   and ( exists ( "Three Hepatitis B Vaccinations" )       or ( exists ( "Meets HepB Vaccination Requirement" )           or exists ( "Hepatitis B Numerator Inclusion Conditions" ) [...]   define "Three Hepatitis B Vaccinations":   from     "Hepatitis B Immunizations or Procedures" HepatitisBVaccination1,     "Hepatitis B Immunizations or Procedures" HepatitisBVaccination2,     "Hepatitis B Immunizations or Procedures" HepatitisBVaccination3     where HepatitisBVaccination2.relevantDatetime 1 day or more after day of HepatitisBVaccination1.relevantDatetime       and HepatitisBVaccination3.relevantDatetime 1 day or more after day of HepatitisBVaccination2.relevantDatetime     return HepatitisBVaccination1   define "Meets HepB Vaccination Requirement":  from       "Hepatitis B Immunizations or Procedures" HepatitisBVaccination1,       "Hepatitis B Immunizations or Procedures" HepatitisBVaccination2,       "NewBorn Vaccine Requirement" NewBornVaccine3         where HepatitisBVaccination2.relevantDatetime 1 day or more after day of HepatitisBVaccination1.relevantDatetime         and HepatitisBVaccination1.relevantDatetime 1 day or more after day of NewBornVaccine3.relevantDatetime         and HepatitisBVaccination2.relevantDatetime 1 day or more after day of NewBornVaccine3.relevantDatetime       return HepatitisBVaccination1    define "NewBorn Vaccine Requirement":  ["Procedure, Performed": "Introduction of Serum, Toxoid and Vaccine into Muscle, Percutaneous Approach"] NewBornVaccine    where Global."ToDateInterval" ( Global."NormalizeInterval" ( NewBornVaccine.relevantDatetime, NewBornVaccine.relevantPeriod ) ) during day of Interval[Patient.birthDatetime, Patient.birthDatetime + 7 days]   define "Hepatitis B Immunizations or Procedures":   ( ( ["Immunization, Administered": "Hepatitis B Vaccine"]       union ["Procedure, Performed": "Hepatitis B Vaccine Administered"] ) HepatitisBVaccination       where Global."ToDateInterval" ( Global."NormalizeInterval" ( HepatitisBVaccination.relevantDatetime, HepatitisBVaccination.relevantPeriod ) ) during day of "First Two Years"  ) Rationale for change ​We are proposing to update the logic for the hepatitis B vaccine requirement to ensure that only one of the three vaccine series may occur during the 8 day period, beginning on the date of birth and ending seven days after the date of birth, using the ICD10 code 3E0234Z. This change will include removing the ICD10 code 3E0234Z from the valueset "Hepatitis B Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1042) and calling it in as a direct reference code in the new logic.