​ Thank you for reaching out with your questions regarding CMS135v11: 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). The Heart Failure Outpatient Encounter does need to take place during the Measurement Period. In the logic which is referenced in your example, “Qualifying Encounter” is referring to the encounter types listed in the Heart Failure Outpatient Encounter definition. Also, the heart failure diagnosis must be documented prior to or during the encounter date/time and still be active during the encounter. The combination of the active heart failure diagnosis and the encounter type allows the patient to qualify for the measure. Diagnoses can be found in a patient’s problem list as well as encounter diagnosis list.

We need clarification on two items related to the Heart Failure Outpatient Encounter: 1) Does the Heart Failure Outpatient Encounter need to take place during the Measurement Year? The Qualifying Encounters are pretty clear ("Qualifying Encounter During Measurement Period"), but is not as clear for the Heart Failure Encounter (exists "Heart Failure Outpatient Encounter"). The narrative text does not specify timing as it does for the Qualifying Encounters, but then the definition of Heart Failure Outpatient Encounter (see below) includes text about overlapping the Qualifying Encounter during the Measurement Period. 2) Does the diagnosis of Heart Failure need to be attached to an Encounter, or can it be an active item on the EHR Problem List? (Our EHR has a Problem List with items that are active until deactivated/resolved by the clinician.) The narrative text only lists "a diagnosis of heart failure", but then the code section refers to "Heart Failure Outpatient Encounter". Again, the definition of Heart Failure Outpatient Encounter (see below) refers to various encounter types listed within the value sets and doesn't seem to allow for pulling from an active Problem List that may be active during the Qualifying Encounters, but not necessarily attached. ---------------------- Heart Failure Outpatient Encounter ( ["Encounter, Performed": "Care Services in Long-Term Residential Facility"] union ["Encounter, Performed": "Home Healthcare Services"] union ["Encounter, Performed": "Nursing Facility Visit"] union ["Encounter, Performed": "Office Visit"] union ["Encounter, Performed": "Outpatient Consultation"] ) QualifyingEncounter with ["Diagnosis": "Heart Failure"] HeartFailure such that HeartFailure.prevalencePeriod overlaps QualifyingEncounter.relevantPeriod where QualifyingEncounter.relevantPeriod during "Measurement Period"