CMS125v13: code "Lives in nursing home (finding)" ("SNOMEDCT Code (160734000)")

XMLWordPrintable

    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Hide
      Thank you for your inquiry regarding the advanced illness and frailty exclusion criteria for CMS125v14. The intent of this exclusion is to identify individuals who are likely to be living in a nursing home any time on or before the end of the measurement period and receiving institutionalized long-term care services.

      To clarify, the exclusion criteria "Is Age 66 or Older Living Long Term in a Nursing Home" requires patients who are 66 years of age or older as of the end of the measurement period where the last housing status assessment performed (LOINC code 71802-3) has a result of "lives in a nursing home (finding)" (SNOMED code 160734000). The measure logic looks for all instances of housing status assessments and filters for the most recent one. After identifying the last housing status, the logic looks for a result of "Lives in nursing home (finding)". Please refer to the snippet of logic below. Clinically equivalent services can be mapped to the codes. If mapping is done, you should maintain documentation in case of a CMS audit.

      AIFrailLTCF.Is Age 66 or Older Living Long Term in a Nursing Home
      ( AgeInYearsAt(date from
      end of "Measurement Period"
      )>= 66
      )
      and ( ( Last(["Assessment, Performed": "Housing status"] HousingStatus
      where Global."NormalizeInterval"(HousingStatus.relevantDatetime, HousingStatus.relevantPeriod) ends on or before day of
      end of "Measurement Period"
      sort by
      end of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)asc
      )) LastHousingStatus
      where LastHousingStatus.result ~ "Lives in nursing home (finding)"
      ) is not null
      Show
      Thank you for your inquiry regarding the advanced illness and frailty exclusion criteria for CMS125v14. The intent of this exclusion is to identify individuals who are likely to be living in a nursing home any time on or before the end of the measurement period and receiving institutionalized long-term care services. To clarify, the exclusion criteria "Is Age 66 or Older Living Long Term in a Nursing Home" requires patients who are 66 years of age or older as of the end of the measurement period where the last housing status assessment performed (LOINC code 71802-3) has a result of "lives in a nursing home (finding)" (SNOMED code 160734000). The measure logic looks for all instances of housing status assessments and filters for the most recent one. After identifying the last housing status, the logic looks for a result of "Lives in nursing home (finding)". Please refer to the snippet of logic below. Clinically equivalent services can be mapped to the codes. If mapping is done, you should maintain documentation in case of a CMS audit. AIFrailLTCF.Is Age 66 or Older Living Long Term in a Nursing Home ( AgeInYearsAt(date from end of "Measurement Period" )>= 66 ) and ( ( Last(["Assessment, Performed": "Housing status"] HousingStatus where Global."NormalizeInterval"(HousingStatus.relevantDatetime, HousingStatus.relevantPeriod) ends on or before day of end of "Measurement Period" sort by end of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)asc )) LastHousingStatus where LastHousingStatus.result ~ "Lives in nursing home (finding)" ) is not null
    • CMS0125v14
    • CMS0125v13

      Hello, 

      The CQL for this measure requires you to look for the most recent housing status. While the CQL provides the code to look for, it doesn't tell us the other housing statuses we also should be looking for so we can find the most recent status.  I see there is a value set from VSAC that houses all the statuses.

      Value Set Name Residence and Accommodation Type
      Code System SNOMEDCT
      OID 2.16.840.1.113883.11.20.9.49
      Type Intensional
      Definition Version 20240606
      Steward HL7 US Realm Program Management
       

      Can I use this overall list and then look for 160734000 to see if it is the most recent? 

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Tara
            Votes:
            0 Vote for this issue
            Watchers:
            3 Start watching this issue

              Created:
              Updated:
              Resolved:
              Solution Posted On: