the CMS Quality Support Team directed me here for answers to my question:

for CMS2v14, If during the first visit of the year, a patient declines or is medically inappropriate for screening and it is documented as such in the medical record (satisfying the exclusion criteria for the measure) and then the same patient has a subsequent qualifying visits during the performance period, but there is no further depression screening documentation in the medical record, does the patient remain not included in the denominator throughout performance period? Or, will they fall into the "not met" bucket after the subsequent visit?

Example: Jane Smith presents in January for her annual physical, at that time, she refuses to be screen, and the provider documents the reason for not screening in the medical record. No other visits have occurred through April. If we ran the year-to-date report in April, the Jane would be removed from the denominator and identified as an exception. Then, in May, Jane Smith presents again for a sick visit and at this visit the patient is not screened and there is no documentation in the medical record as to why she was not screened. This is her last visit of the performance period. For the final report of that performance period, would Jane still appear as an exception and not in the denominator or would she be in the denominator and fail the measure since no additional screenings or documentation were included in the Jane's medical record during the performance period? Many thanks for your guidance on this.