​ Hello. Thank you for reaching out with your question regarding CMS135v10, Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD). Population 2 is intended to measure patients at each hospital discharge. If a patient has multiple hospital discharges where a diagnosis of Moderate or Severe LVSD exists, each discharge should be considered in the denominator and numerator of the measure. Please refer to the Rate Aggregation section of the measure header for more information on how this measure is calculated.   This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes: - Population 1: Patients who were prescribed ACE inhibitor or ARB or ARNI therapy within a 12-month period when seen in the outpatient setting - Population 2: Patients who were prescribed ACE inhibitor or ARB or ARNI therapy at each hospital discharge   For the purposes of this measure, a single performance rate can be calculated as follows: Performance Rate = (Numerator 1 + Numerator 2)/ [(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)]   Starting with CMS135v11, Population 2 has been removed from this measure. Please let us know if you have additional questions.

Based on the specification, multiple events contribute to numerator and denominator criteria. Is the CMS135 measure intended to allow for patients to be counted more than once in the numerator and denominator for population 2? Or, should a single patient be counted only once in the numerator and denominator? In example, where a member is counted more than once in the denominator; Example: patient is counted in the denominator 3x with a heart failure IP encounter date of March, May, and June of the measurement period with a heart failure dx. Date of Moderate severe LVSD January 6 for all 3 encounters. Would we expect the final denominator count to include this patient 3 times?