Brief Description of Measure: CMS122: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period Description of Issue: Add the new glucose management indicator (GMI) into the measure as another way to meet numerator criteria, as per updated guidelines. This measure update will require updates throughout the header and logic because "Hemoglobin A1c" does not capture the addition of the GMI value.

Proposed Solution: CMS122 Title //before: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)   //after: Diabetes: Glycemic Status Assessment >9%   CMS122 Description Section //before: Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period //after: Percentage of patients 18-75 years of age with diabetes who had a glycemic status assessment (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) > 9.0% during the measurement period   CMS122 Guidance Section //before: If the HbA1c test result is in the medical record, the test can be used to determine numerator compliance. //after: If the glycemic status assessment (HbA1c or GMI) is in the medical record, the test can be used to determine numerator compliance. Glycemic status assessment (HbA1c or GMI) must be reported as a percentage (%). If multiple glycemic status assessments were recorded for a single date, use the lowest result.   CMS122 Numerator //before: Patients whose most recent HbA1c level (performed during the measurement period) is >9.0% or is missing, or was not performed during the measurement period   //after: Patients whose most recent glycemic status assessment (HbA1c or GMI) (performed during the measurement period) is >9.0% or is missing, or was not performed during the measurement period   CMS122 Logic //before: Numerator "Has Most Recent HbA1c Without Result" or "Has Most Recent Elevated HbA1c" or "Has No Record Of HbA1c"   //after: Numerator "Has Most Recent Glycemic Status Assessment Without Result" or "Has Most Recent Elevated Glycemic Status Assessment" or "Has No Record Of Glycemic Status Assessment"   //before: Most Recent HbA1c Last( ["Laboratory Test, Performed": "HbA1c Laboratory Test"] RecentHbA1c                   where Global."LatestOf"(RecentHbA1c.relevantDatetime, RecentHbA1c. relevantPeriod)during day of "Measurement Period"                   sort by start of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)                )   Has Most Recent Elevated HbA1c "Most Recent HbA1c".result > 9 '%' Has Most Recent HbA1c Without Result "Most Recent HbA1c" is not null and "Most Recent HbA1c".result is null   Has No Record Of HbA1c not exists ["Laboratory Test, Performed": "HbA1c Laboratory Test"] NoHbA1c where Global."LatestOf" ( NoHbA1c.relevantDatetime, NoHbA1c.relevantPeriod ) during day of "Measurement Period"   //after (Add LOINC code 97506-0 "Glucose management indicator"): Most Recent Glycemic Status Assessment Last( ( ["Laboratory Test, Performed": "HbA1c Laboratory Test"] union ["Laboratory Test, Performed": "Glucose management indicator"]) RecentGlycemicStatusAssessment    where Global."LatestOf"(RecentGlycemicStatusAssessment.relevantDatetime, RecentGlycemicStatusAssessment. relevantPeriod)during day of "Measurement Period"    sort by start of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)                )   Has Most Recent Elevated Glycemic Status Assessment "Most Recent Glycemic Status Assessment".result > 9 '%'   Has Most Recent Glycemic Status Assessment Without Result ( "Most Recent Glycemic Status Assessment" is not null  and "Most Recent Glycemic Status Assessment".result is null )   Has No Record Of Glycemic Status Assessment  ( not exists ["Laboratory Test, Performed": "HbA1c Laboratory Test"] NoHbA1c  where Global."LatestOf" ( NoHbA1c.relevantDatetime, NoHbA1c.relevantPeriod ) during day of "Measurement Period") or ( not exists ["Laboratory Test, Performed": "Glucose management indicator"] NoGlucoseIndicator    where Global."LatestOf" ( NoGlucoseIndicator.relevantDatetime, NoGlucoseIndicator.relevantPeriod ) during day of "Measurement Period"                 ) Rationale for Change: Adding glucose management indicator (GMI) into the measure as another option to meet numerator criteria to meet measure intent based on updated standards of care ( https://diabetesjournals.org/care/article/46/Supplement_1/S97/148053/6-Glycemic-Targets-Standards-of-Care-in-Diabetes ).