Hello, I am reaching out on behalf of our quality team to request clarification regarding the denominator exclusion for the eCQM CMS 506 - Safe Use of Opioids. The denominator exclusion indicates that patients discharged to another inpatient care facility should be excluded from the measure. We are seeking clarification on how this exclusion should be applied in our organization, as we operate under a multi-facility structure. Specifically, our main hospital frequently discharges patients to: Our Critical Access Hospitals (CAHs) for continued inpatient care or swing bed services, and An inpatient psychiatric unit that is physically located within our main hospital, to which patients are transferred once they are medically stabilized. Currently, when patients are discharged from the main hospital to either one of our CAHs or to the inpatient psychiatric unit, they are being included in the numerator, as these discharges are not being treated as exclusions for transfer to another inpatient care facility. We would appreciate clarification on whether: Critical Access Hospitals receiving patients for inpatient or swing bed services, and An inpatient psychiatric unit within the same hospital are considered "inpatient care facilities" for the purposes of the CMS 506 denominator exclusion. Thank you for your time and guidance on this matter. We appreciate any clarification you can provide.