CMS68v15 measure CQL file and specification document has the following statement in Denominator exception. Here the last reason for medication not documented ("MedicationsNotDocumented.negationRationale = "Acute health crisis (finding)") is having "=" (equal to) operator But none of the CMS measures had such operator in the past for any measures.

So, my question here, Is it mandatory to use the "=" (equal to) operator or can we use the "~" (equivalence operator) operator instead?

Snippet from CMS68v15 measure specification{}

Note: I found the FHIR resource for this measure in https://build.fhir.org/ig/cqframework/dqm-content-qicore-2025/Measure-CMS68FHIRDocumentationCurrentMeds.html?utm_source=chatgpt.com, Denominator exception has "~" (equivalence operator)