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 Nutrition Assessment. Different results during the same encounter may lead to erroneous calculations. The measure steward proposes updating the logic to allow the “Not/Mildly Malnourished” result to take priority over “Moderate Malnutrition” or “Severe Malnutrition” at any point during the eligible encounter. This update aligns with measure intent and will facilitate accurate performance calculation.

Proposed Solution: Update the logic such that the "Not/Mildly Malnourished" result takes priority at any point during the eligible encounter over any "Moderate Malnutrition" or "Severe Malnutrition" result. Proposed logic: define function "MeasureObservation 3"(Encounter "Encounter, Performed" ):   if ( "Encounter with Malnutrition Not at Risk Result and without Hospital Dietitian Referral" ) contains Encounter     or ( "Encounter with Nutrition Assessment Status Not or Mildly Malnourished" ) contains Encounter then 0     else if ( "Encounter with Malnutrition Diagnosis" contains Encounter       and "Encounter with Nutrition Assessment and Identified Status" contains Encounter       and ( ( "Encounter with Nutrition Assessment Status Moderately Malnourished" contains Encounter             or "Encounter with Nutrition Assessment Status Severely Malnourished" contains Encounter         )       )   ) then 1     else 0 define function "MeasureObservation 4"(Encounter "Encounter, Performed" ):   if ( "Encounter with Malnutrition Not at Risk Result and without Hospital Dietitian Referral" ) contains Encounter     or ( "Encounter with Nutrition Assessment Status Not or Mildly Malnourished" ) contains Encounter then 0     else if ( "Encounter with Nutrition Care Plan" contains Encounter       and "Encounter with Nutrition Assessment and Identified Status" contains Encounter       and ( ( "Encounter with Nutrition Assessment Status Moderately Malnourished" contains Encounter             or "Encounter with Nutrition Assessment Status Severely Malnourished" contains Encounter         )       )   ) then 1     else 0 Rationale for Change: This logic update aligns with the measure intent for the “Not/Mildly Malnourished” result to be prioritized in instances where there are multiple results during an eligible encounter.