We appreciate your patience in waiting for a response on this issue. While the original steward confirmed recently that the measure does not need to have any clinical content update and that it still reflects evidence-based medicine, they are no longer providing ongoing stewardship of the measure specification. Therefore, CMS/ONC intends to maintain the measure for the time being as specified. Whether a provider wants to report this measure is their choice. CMS 169 is a patient-based measure, and according to the specification, if a patient has two qualifying encounters in the denominator, then an assessment for alcohol/substance abuse on either one would put the patient in the numerator. It's worth noting, however, that the measure author provided guidance suggesting this is not the ideal solution in the past and that the true intent was to perform the assessment for each episode for each patient. Due to current limitations of the eMeasure specification system, it is possible for there to be up to two treatment episodes per patient, identified through up to two index episodes. As a result, the numerator criteria of this measure can be satisfied if a substance use assessment is performed within either treatment episode. Future versions of the measure should address this issue, but for the time being any assessment satisfies the measure performance. That said, it's difficult to ascertain exactly what the measure author did intend to specify. If they really mean to only evaluate a "single episode for each patient", then they don't provide guidance regarding which one (FIRST or LAST). If they want to ensure that every episode has an accompanying assessment of alcohol/substance abuse to qualify for the numerator, then this is probably possible but would make for some complex QDM code. Regarding whether or not this is an Episode of Care measure, it doesn't seem likely since: (1) the prose descriptions don't seem to suggest it, (2) the IPP doesn't contain encounters, and (3) most Episode of Care measures tend to be EH (although there are a couple of EP ones). Changing the measure to focus on episodes of care may be a technical solution to this issue in the future, but until the measure regains a clinical steward, expect the logic will remain largely unchanged.