Thank you for your question regarding CMS816v3, Hospital Harm – Severe Hypoglycemia, and CMS871v3, Hospital Harm – Severe Hyperglycemia. Because regular glucose checks are considered to be integral clinical care for patients who are at high risk of experiencing a hypoglycemic or hyperglycemic event, it is not appropriate to include exclusions or exceptions for patients who refuse a glucose check. Both measures assess inpatient hospitalizations for the occurrence of a hypoglycemic or hyperglycemic event among patients who are most at risk for experiencing one of these events. Specifically, CMS816v3: Hospital Harm – Severe Hypoglycemia’s Denominator includes patients who are administered at least one hypoglycemic medication during the encounter, while CMS871v3: Hospital Harm – Severe Hyperglycemia’s Denominator includes patients who have a diagnosis of diabetes that starts before the end of the encounter, who are administered at least one dose of insulin or any hypoglycemic medication during the encounter, or who have at least one glucose value >=200 mg/dL at any time during the encounter. While the eCQM Issue Tracker is the correct venue to submit questions about eCQMs and suggested eCQM updates, we are not considering any future updates to expand these measures' exclusions or exceptions criteria at this time.