Brief Description of Measures: CMS146: Appropriate Testing for Pharyngitis CMS154: Appropriate Treatment for Upper Respiratory Infection (URI) CMS136: Follow-Up Care for Children Prescribed ADHD Medication (ADD) CMS137: Initiation and Engagement of Substance Use Disorder Treatment CMS165: Controlling High Blood Pressure CMS125: Breast Cancer Screening CMS130: Colorectal Cancer Screening CMS131: Diabetes: Eye Exam CMS122: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) Description of Issue: Value sets with obsolete codes and exhausted lookback periods will be removed from the measures: "Initial Hospital Observation Care" (2.16.840.1.113883.3.464.1003.101.12.1002) • CPT 99218 Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to outpatient hospital "observation status" are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit. • CPT 99219 Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to outpatient hospital "observation status" are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient's hospital floor or unit. • CPT 99220 Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to outpatient hospital "observation status" are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit. "Observation" (2.16.840.1.113883.3.464.1003.101.12.1086) • CPT 99217 Observation care discharge day management (This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital "observation status" if the discharge is on other than the initial date of "observation status." To report services to a patient designated as "observation status" or "inpatient status" and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.]) • CPT 99218 Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to outpatient hospital "observation status" are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit. • CPT 99219 Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to outpatient hospital "observation status" are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient's hospital floor or unit. • CPT 99220 Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to outpatient hospital "observation status" are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit.

Proposed Solution: Example from CMS154: //Before define "Qualifying Encounters":   ( ["Encounter, Performed": "Emergency Department Evaluation and Management Visit"]     union ["Encounter, Performed": "Home Healthcare Services"]     union ["Encounter, Performed": "Initial Hospital Observation Care"]     union ["Encounter, Performed": "Medical Disability Exam"]     union ["Encounter, Performed": "Observation"]     union ["Encounter, Performed": "Office Visit"]     union ["Encounter, Performed": "Outpatient Consultation"]     union ["Encounter, Performed": "Preventive Care Services Group Counseling"]     union ["Encounter, Performed": "Preventive Care Services Individual Counseling"]     union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"]     union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]     union ["Encounter, Performed": "Preventive Care Services Established Office Visit, 18 and Up"]     union ["Encounter, Performed": "Preventive Care Services Initial Office Visit, 18 and Up"]     union ["Encounter, Performed": "Telephone Visits"]     union ["Encounter, Performed": "Online Assessments"]     union ["Encounter, Performed": "Unlisted preventive medicine service"] ) ValidEncounters     where ValidEncounters.relevantPeriod ends during day of Interval[start of "Measurement Period",     end of "Measurement Period" - 3 days] //After "Initial Hospital Observation Care" and "Observation" value sets are removed. define "Qualifying Encounters":   ( ["Encounter, Performed": "Emergency Department Evaluation and Management Visit"]     union ["Encounter, Performed": "Home Healthcare Services"]     union ["Encounter, Performed": "Medical Disability Exam"]     union ["Encounter, Performed": "Office Visit"]     union ["Encounter, Performed": "Outpatient Consultation"]     union ["Encounter, Performed": "Preventive Care Services Group Counseling"]     union ["Encounter, Performed": "Preventive Care Services Individual Counseling"]     union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"]     union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]     union ["Encounter, Performed": "Preventive Care Services Established Office Visit, 18 and Up"]     union ["Encounter, Performed": "Preventive Care Services Initial Office Visit, 18 and Up"]     union ["Encounter, Performed": "Telephone Visits"]     union ["Encounter, Performed": "Online Assessments"]     union ["Encounter, Performed": "Unlisted preventive medicine service"] ) ValidEncounters     where ValidEncounters.relevantPeriod ends during day of Interval[start of "Measurement Period",     end of "Measurement Period" - 3 days] Rationale for Change: These value sets are no longer relevant for the measures.