*Please review updates to the proposed changes for the Malnutrition Risk Screening: Proposed Value Set Expansion value set (OID 2.16.840.1.113762.1.4.1095.92)* [Note code changes in RED in the new attachment on this ticket.] Brief Description of Measure: CMS986/GMCS: Global Malnutrition Composite Score This measure assesses the percentage of hospitalizations for adults aged 65 years and older at the start of the inpatient encounter during the measurement period with a length of stay equal to or greater than 24 hours who received optimal malnutrition care during the current inpatient hospitalization where care performed was appropriate to the patient's level of malnutrition risk and severity. Malnutrition care best practices recommend that for each hospitalization, adult inpatients are screened for malnutrition risk, assessed to confirm findings of malnutrition risk or for a hospital dietitian referral order, and if identified with a "moderate" or "severe" malnutrition status in the current performed malnutrition assessment, receive a current "moderate" or "severe" malnutrition diagnosis and have a current nutrition care plan performed. Description of Issue: The measure developer is proposing updates to the value set content to reflect Technical Expert Panel (TEP) feedback as well as new coding and terminology updates. Updates will better align with the measure intent and target population.

Proposed Solution: See attachment for the proposed revision of the following value sets: Revision of the following value set contents due to new code releases and workgroup recommendations: Malnutrition Risk Screening (OID 2.16.840.1.113762.1.4.1095.92) Nutrition Assessment (OID 2.16.840.1.113762.1.4.1095.21) Malnutrition Screening Not At Risk Result (OID 2.16.840.1.113762.1.4.1095.34) Malnutrition Diagnosis (OID 2.16.840.1.113762.1.4.1095.55) Nutrition Care Plan value set (OID 2.16.840.1.113762.1.4.1095.93) Changes include removal of ICD- 9 from one grouping value set, revision of the value set names, addition of SNOMED- CT, LOINC, and ICD-10 codes to represent Malnutrition Risk Screening, Nutrition Assessment, Malnutrition Diagnosis, Nutrition Care Plan, and results or findings of Nutrition Assessment and Malnutrition Screening. Changes for Malnutrition Screening At Risk Result due to new code releases and technical advisory panel recommendations: 1) Revision of existing grouping value set (OID 2.16.840.1.113762.1.4.1095.89) name and removal of Malnutrition Screening at Risk Result-ICD 9 (OID 2.16.840.1.113762.1.4.1095.31) from the grouping. 2) Revision of the existing SNOMED CT value set name, Malnutrition Screening At Risk Result (OID 2.16.840.1.113762.1.4.1095.38). No changes are recommended for the expansion. 3) Addition of a LOINC value set to the grouping. Changes for Nutrition Assessment Status Not or Mildly Malnourished due to new code releases and technical advisory panel recommendations: 1) Creation of a NEW grouping value set. 2) Revision of the existing SNOMED CT value set name Nutrition Assessment Status Not or Mildly Malnourished (OID 2.16.840.1.113762.1.4.1095.48) and changes to the expansion. 3) Addition of a LOINC value set to the grouping. Changes for Nutrition Assessment Status Moderately Malnourished due to new code releases and technical advisory panel recommendations: 1) Revision of existing grouping value set (OID 2.16.840.1.113762.1.4.1095.47) name. Removal of the following value sets from the grouping: Nutritional Status Moderately Malnourished-ICD9 (OID 2.16.840.1.113762.1.4.1095.45) and Nutritional Status Moderately Malnourished-ICD 10 (OID 2.16.840.1.113762.1.4.1095.46). 2) Revision of the existing SNOMED CT value set name Nutrition Assessment Status Moderately Malnourished (OID 2.16.840.1.113762.1.4.1095.44) and changes to the expansion. 3) Addition of a LOINC value set to the grouping. Changes for Nutrition Assessment Status Severely Malnourished due to new code releases and technical advisory panel recommendations: 1) Revision of existing grouping value set (OID 2.16.840.1.113762.1.4.1095.43) name. Removal of the following value sets from the grouping: Nutritional Status Severely Malnourished-ICD9 (OID 2.16.840.1.113762.1.4.1095.25) and Nutritional Status Severely Malnourished-ICD 10 (OID 2.16.840.1.113762.1.4.1095.41). 2) Revision of the existing SNOMED CT value set name Nutrition Assessment Status Severely Malnourished (OID 2.16.840.1.113762.1.4.1095.42) and changes to the expansion. 3) Addition of a LOINC value set to the grouping. Rationale for Change: Value sets will be updated to align with standards and improve data capture.