Thank you for your question on CMS2v13: Preventive Care and Screening: Screening for Depression and Follow-Up Plan. A patient refusing the provider's treatment plan does not qualify for the Denominator Exception. The Denominator Exception only looks at if the patient refuses to participate in or complete the depression screening or if there is a medical reason for not completing the depression screening. In your example, if the provider documents the treatment plan on the date of or up to two days after the date of the qualifying encounter, the patient will meet the Numerator even if they refused treatment. The measure does not capture if the patient received treatment but if the follow-up plan was documented.