Thank you for your inquiry about CMS816v3 the Hospital Harm – Severe Hypoglycemia eCQM. We have considered whether terminally ill and critically ill patients should be included in the measure. We understand that for these patients the glucose level can become very low for reasons not related to medication. However, in order for the hypoglycemic event to be considered a harm event, the measure specification requires the administration of an antihyperglycemic medication 24 hours prior to the event. It may be difficult to see a reason that such patients will need antihyperglycemic medications at this stage of life, but if they are given medications to control for high glucose, proper monitoring and appropriate dosing should be continued to prevent severe hypoglycemia.