Brief Description of Measure: CMS128: Anti-depressant Medication Management Percentage of patients 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. Two rates are reported. a. Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks). b. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months). Description of Issue: Currently, the age criteria for the initial population in this measure looks for "patients 18 years of age and older as of April 30 of the measurement period". To align with the measure intent the measure developer proposes adjusting the age criteria to look for "patients 18 years of age and older as of the IPSD [Index Prescription Start Date]". The Index Prescription Start Date (IPSD) is the date of the earliest prescription dispensing event for an antidepressant medication during the Intake Period. The Intake Period is the 12-month window starting on May 1 of the year prior to the measurement period and ending on April 30 of the measurement period. The proposed adjustment to the timing criteria establishes that patients are at least 18 years of age at the time of the measurement period and dispensed antidepressant medication during the intake period. Anchoring the age requirement to the Index Prescription Start Date rather than the general intake period establishes that every individual captured in the measure’s denominator is at least 18 years of age at the time they start their antidepressant medication treatment. The 18 years of age threshold was specified based on guidelines, expert consensus, and FDA approval of the medications.

Proposed Solution: Initial Population Header Before: "Patients 18 years of age and older as of April 30 of the measurement period..." Initial Population Header After: "Patients 18 years of age and older as of the IPSD..." Initial Population Logic Before: define "Initial Population":   AgeInYearsAt(date from "April 30 of the Measurement Period") >= 18     and "Has IPSD and Major Depression Diagnosis"     and exists "Qualifying Encounters" Initial Population Logic After: define "Initial Population":   AgeInYearsAt(date from "IPSD") >= 18     and "Has IPSD and Major Depression Diagnosis"     and exists "Qualifying Encounters" Note "IPSD" is an existing definition and a requirement for the Initial Population. The Initial Population looks for "Patients 18 years of age and older as of April 30 of the measurement period who were dispensed antidepressant medications during the Intake Period, and were diagnosed with major depression 60 days prior to, or 60 days after the dispensing event and had a visit 60 days prior to, or 60 days after the dispensing event". Rationale for Change: This update aligns the measure logic and measure intent to capture patients 18 years of age and older at the time of the index prescription start date.