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: Throughout an eligible encounter, patients may develop multiple results for the Malnutrition Risk Screening. The measure steward proposes updating the logic to allow the "Not at Risk" result to take priority over any "At Risk" result at any point during the eligible encounter. This update aligns with measure intent and will facilitate accurate performance calculation.

Proposed Solution: The measure steward proposes adding an additional definition, specifically "Encounter with Malnutrition Risk Screening Not at Risk Result and without Hospital Dietitian Referral" with the following logic: define "Encounter with Malnutrition Not at Risk Result and without Hospital Dietitian Referral":   "Qualifying Encounter" QualifyingEncounter     with ["Assessment, Performed": "Malnutrition Risk Screening"] MalnutritionRiskScreening       such that exists ( "Encounter with Malnutrition Screening Not At Risk Result" )         and not exists ( "Encounter with Hospital Dietitian Referral" ) Additionally, the logic definition for "Encounter with Malnutrition Risk Screening At Risk Result" will be modified to include the following phrase:  and not ( exists "Encounter with Malnutrition Screening Not At Risk Result" ) Finally, the logic definition for "Encounter with Nutrition Assessment and Identified Status" will be modified to include the following phrase: and not ( exists "Malnutrition Screening Not At Risk Result" ) Rationale for Change: This logic update aligns with the measure intent for the “Not at Risk” result to be prioritized in instances where there are multiple results during an eligible encounter.