Metadata
Title | HIV ScreeningFHIR
Version | 1.1.000
Short Name | CMS349FHIR
GUID (Version Independent) | urn:uuid:40b617bf-3054-4663-bf9c-a15417c9a7dc
GUID (Version Specific) | urn:uuid:2ecafb2e-b48a-44e6-9e10-4a9db778cf97
CMS Identifier | 349FHIR
Effective Period | 2026-01-01 through 2026-12-31
Steward (Publisher) | Centers for Disease Control and Prevention (CDC)
Developer | Centers for Disease Control and Prevention (CDC)
Description | Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for human immunodeficiency virus (HIV)
Copyright | Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. CDC disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association. LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved.
Disclaimer | The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Rationale | HIV is a communicable infection that leads to a progressive disease with a long asymptomatic period. Although progress has been made with an overall 12% decline in estimated HIV infections from 2018 to 2022, CDC estimated 31,800 new HIV infections in the United States in 2022 (Centers for Disease Control and Prevention, 2024a). Without treatment, most persons develop acquired immunodeficiency syndrome (AIDS) within 10 years of HIV infection. Antiretroviral therapy (ART) delays this progression and increases the length of survival, but it is most effective when initiated during the asymptomatic phase. Persons living with HIV who use ART and achieve viral suppression can have a nearly normal life expectancy (Samji et al., 2013). The Department of Health and Human Services (DHHS) Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents recommends immediate antiretroviral therapy for all HIV-infected individuals, regardless of CD4 count at diagnosis, to reduce the risk of disease progression (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022). CDC estimates that, in 2022, approximately 13% of the 1.2 million adults and adolescents living with HIV infection in the United States were unaware of their infection (CDC, 2024a). Among persons diagnosed with HIV in 2022, approximately 21% were diagnosed with Stage 3 HIV (AIDS) at the time of HIV diagnosis (CDC, 2024b), which is when there is a CD4 lymphocyte count of less than 200 cells/mm3 or a CD4 percentage of total lymphocytes of less than 14 or documentation of AIDS-defining condition at diagnosis (CDC, 2024b). HIV screening identifies infected persons who were previously unaware of their infection, which enables them to seek medical and social services that can improve their health and the quality and length of their lives. Additionally, using ART with high levels of medication adherence has been shown to substantially reduce the risk of HIV transmission (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022). Based on the Behavioral Risk Factor Surveillance System (BRFSS), the percentage of ever tested for HIV increased from 42.9% in 2011 to 45.9% in 2017. Despite this increase, less than half of US adults have ever been tested for HIV over ten years after CDC's recommendations (Patel et al., 2020).
Clinical Recommendation Statement | The US Preventive Services Task Force recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened (A Recommendation) (Owens, et al., 2019). Since 2006, the CDC has recommended routine opt-out HIV screening (i.e., patient is notified that testing will be performed unless the patient declines) in healthcare facilities of adolescents and adults 13-64 years of age and HIV diagnostic testing of adolescents and adults with clinical signs or symptoms consistent with HIV infection (Centers for Disease Control and Prevention, 2006).
Citation | Centers for Disease Control and Prevention. (2024a). HIV Surveillance Supplemental Report: Estimated HIV Incidence and Prevalence in the United States, 2018–2022. HIV Surveillance Supplemental Report 2024;29 (No. 1). Retrieved from https://stacks.cdc.gov/view/cdc/156513.
Citation | Centers for Disease Control and Prevention. (2024b). HIV Surveillance Supplemental Report: Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data United States and 6 Territories and Freely Associated States, 2022. HIV Surveillance Supplemental Report 2024;29 (No. 2). Retrieved from https://stacks.cdc.gov/view/cdc/156511.
Citation | Centers for Disease Control and Prevention. (2006). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health care settings. Morbidity and Mortality Weekly Report, 55(RR-14), 1-17.
Citation | Owens, on behalf of the U.S. Preventive Task Force. (2019). Screening for HIV: US Preventive Services Task Force Recommendation Statement. JAMA, 321(23), 2326-2336.
Citation | Panel on Antiretroviral Guidelines for Adults and Adolescents. (2022). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Retrieved from https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf
Citation | Patel, D., Johnson, C.H., Krueger, A. et al. (2019). Trends in HIV Testing Among US Adults, Aged 18–64 Years, 2011–2017. AIDS and Behavior, 24(2), 532. https://doi.org/10.1007/s10461-019-02689-0'
Citation | Samji, H., Cescon, A., Hogg, R. S., Modur, S. P., Althoff, K. N., Buchacz, K., ... & North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA. (2013). Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One, 8(12), e81355.
Guidance (Usage) | This measure evaluates the proportion of patients aged 15 to 65 at the start of the measurement period who have documentation of having received an HIV test at least once on or after their 15th birthday and before their 66th birthday. In order to satisfy the measure, the reporting provider must have documentation of the administration of a laboratory or point of care (POC) test present in the patient's medical record. In cases where the HIV test was performed elsewhere, providers cannot rely on patient attestation or self-report to meet the measure requirements, as previous research has shown that patient self-report is an unreliable indicator of previous HIV testing history. Rather, providers must request documentation of those test results. If such documentation is not available, the patient should be considered still eligible for HIV screening. If such documentation is available, but cannot be provided in a standardized, structured format (such that the laboratory or point of care (POC) test and results can be readily incorporated as structured data within the EHR), providers should enter the information into their EHR as a laboratory test in a manner consistent with the EHR in use. If the specific Human Immunodeficiency Virus (HIV) Laboratory Test LOINC code of the test is not known, the entry should use the more generic code LOINC panel code [75622-1]. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure CMS349v8. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).
Measure Group (Rate) (ID: Group_1)
Basis | boolean
Scoring | [http://terminology.hl7.org/CodeSystem/measure-scoring#proportion: 'Proportion']
Type | [http://terminology.hl7.org/CodeSystem/measure-type#process: 'Process']
Improvement Notation | [http://terminology.hl7.org/CodeSystem/measure-improvement-notation#increase: 'Increased score indicates improvement']
Initial Population | ID: InitialPopulation_1 Description: Patients 15 to 65 years of age at the start of the measurement period without an HIV diagnosis prior to the start of the measurement period AND who had at least one outpatient visit during the day of the measurement period Logic Definition: Initial Population
Denominator | ID: Denominator_1 Description: Equals Initial Population Logic Definition: Denominator
Denominator Exclusion | ID: DenominatorExclusion_1 Description: Patients diagnosed with HIV prior to the day of the start of the measurement period Logic Definition: Denominator Exclusions
Numerator | ID: Numerator_1 Description: Patients with documentation of an HIV test performed on or after their 15th birthday and before their 66th birthday Logic Definition: Numerator
Denominator Exception | ID: DenominatorException_1 Description: Patients who die on or before the end of the day of the measurement period Logic Definition: Denominator Exceptions
Supplemental Data Guidance | For every patient evaluated by this measure also identify payer, race, ethnicity and sex
Supplemental Data Elements
Supplemental Data Element | ID: sde-ethnicity Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Ethnicity Logic Definition: SDE Ethnicity
Supplemental Data Element | ID: sde-payer Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Payer Logic Definition: SDE Payer
Supplemental Data Element | ID: sde-race Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Race Logic Definition: SDE Race
Supplemental Data Element | ID: sde-sex Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Sex Logic Definition: SDE Sex
Measure Logic
Primary Library | https://madie.cms.gov/Library/CMS349FHIRHIVScreening
Contents | Population Criteria Logic Definitions Terminology Dependencies Data Requirements
Population Criteria
Measure Group (Rate) (ID: Group_1)
Initial Population
    define "Initial Population":
      AgeInYearsAt(date from start of "Measurement Period") in Interval[15, 65]
        and exists "Qualifying Encounters"
Denominator
    define "Denominator":
      "Initial Population"
Denominator Exclusion
    define "Denominator Exclusions":
      exists ( ( [ConditionProblemsHealthConcerns: "HIV"]
          union [ConditionEncounterDiagnosis: "HIV"] ) HIVDiagnosis
          where HIVDiagnosis.prevalenceInterval ( ) starts before day of start of "Measurement Period"
            and HIVDiagnosis.isVerified ( )
      )
Numerator
    define "Numerator":
      ( "Has HIV Test Performed" )
Denominator Exception
    define "Denominator Exceptions":
      "Patient Expired"
Logic Definitions
Logic Definition | Library Name: SupplementalDataElements
    define "SDE Sex":
      case
        when Patient.sex = '248153007' then "Male (finding)"
        when Patient.sex = '248152002' then "Female (finding)"
        else null
      end
Logic Definition | Library Name: SupplementalDataElements
    define "SDE Payer":
      [Coverage: type in "Payer Type"] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }
Logic Definition | Library Name: SupplementalDataElements
    define "SDE Ethnicity":
      Patient.ethnicity E
        return Tuple {
          codes: { E.ombCategory } union E.detailed,
          display: E.text
        }
Logic Definition | Library Name: SupplementalDataElements
    define "SDE Race":
      Patient.race R
        return Tuple {
          codes: R.ombCategory union R.detailed,
          display: R.text
        }
Logic Definition | Library Name: CMS349FHIRHIVScreening
    define "SDE Sex":
      SDE."SDE Sex"
Logic Definition | Library Name: CMS349FHIRHIVScreening
    define "Has HIV Test Performed":
      exists ( ["LaboratoryResultObservation": "Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag)"]
        union ["LaboratoryResultObservation": "HIV 1 and 2 tests - Meaningful Use set"] ) HIVTest
        where HIVTest.value is not null
          and AgeInYearsAt(date from start of HIVTest.effective.toInterval()) in Interval[15, 65]
          and HIVTest.effective.toInterval ( ) starts before day of end of "Measurement Period"
          and ( HIVTest.status = 'final'
              or HIVTest.status = 'amended'
              or HIVTest.status = 'corrected'
          )
Logic Definition | Library Name: CMS349FHIRHIVScreening
    define "Numerator":
      ( "Has HIV Test Performed" )
Logic Definition | Library Name: CMS349FHIRHIVScreening
    define "Qualifying Encounters":
      ( ["Encounter": "Preventive Care Services, Initial Office Visit, 0 to 17"]
        union ["Encounter": "Preventive Care Services-Initial Office Visit, 18 and Up"]
        union ["Encounter": "Preventive Care, Established Office Visit, 0 to 17"]
        union ["Encounter": "Preventive Care Services - Established Office Visit, 18 and Up"]
        union ["Encounter": "Office Visit"] ) Encounter
        where Encounter.period during day of "Measurement Period"
          and Encounter.status = 'finished'
Logic Definition | Library Name: CMS349FHIRHIVScreening
    define "Initial Population":
      AgeInYearsAt(date from start of "Measurement Period") in Interval[15, 65]
        and exists "Qualifying Encounters"
Logic Definition | Library Name: CMS349FHIRHIVScreening
    define "Denominator":
      "Initial Population"
Logic Definition | Library Name: CMS349FHIRHIVScreening
    define "SDE Payer":
      SDE."SDE Payer"
Logic Definition | Library Name: CMS349FHIRHIVScreening
    define "SDE Ethnicity":
      SDE."SDE Ethnicity"
Logic Definition | Library Name: CMS349FHIRHIVScreening
    define "Denominator Exclusions":
      exists ( ( [ConditionProblemsHealthConcerns: "HIV"]
          union [ConditionEncounterDiagnosis: "HIV"] ) HIVDiagnosis
          where HIVDiagnosis.prevalenceInterval ( ) starts before day of start of "Measurement Period"
            and HIVDiagnosis.isVerified ( )
      )
Logic Definition | Library Name: CMS349FHIRHIVScreening
    define "SDE Race":
      SDE."SDE Race"
Logic Definition | Library Name: CMS349FHIRHIVScreening
    define "Patient Expired":
      Patient.deceased on or before day of end of "Measurement Period"
Logic Definition | Library Name: CMS349FHIRHIVScreening
    define "Denominator Exceptions":
      "Patient Expired"
Logic Definition | Library Name: FHIRHelpers
    define function ToString(value uri): value.value
Logic Definition | Library Name: FHIRHelpers
    /*
    @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
    value to a CQL DateTime Interval
    @comment: If the start value of the given period is unspecified, the starting
    boundary of the resulting interval will be open (meaning the start of the interval
    is unknown, as opposed to interpreted as the beginning of time).
    */
    define function ToInterval(period FHIR.Period):
        if period is null then
            null
        else
            if period."start" is null then
                Interval(period."start".value, period."end".value]
            else
                Interval[period."start".value, period."end".value]
Logic Definition | Library Name: FHIRHelpers
    /*
    @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
    */
    define function ToCode(coding FHIR.Coding):
        if coding is null then
            null
        else
            System.Code {
              code: coding.code.value,
              system: coding.system.value,
              version: coding.version.value,
              display: coding.display.value
            }
Terminology
Code System | Description: Code system SNOMEDCT Resource: http://snomed.info/sct Canonical URL: `http://snomed.info/sct`
Code System | Description: Code system LOINC Resource: http://loinc.org Canonical URL: `http://loinc.org`
Value Set | Code System | Description: Value set Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag) Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1056.50 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1056.50`
Value Set | Description: Value set Preventive Care Services, Initial Office Visit, 0 to 17 Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022`
Value Set | Description: Value set Preventive Care Services-Initial Office Visit, 18 and Up Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023`
Value Set | Description: Value set Preventive Care, Established Office Visit, 0 to 17 Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024`
Value Set | Description: Value set Preventive Care Services - Established Office Visit, 18 and Up Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025`
Value Set | Description: Value set Office Visit Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001`
Value Set | Description: Value set Payer Type Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591`
Value Set | Description: Value set HIV Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003`
Direct Reference Code | Display: Male (finding) Code: 248153007 System: `http://snomed.info/sct`
Direct Reference Code | Display: Female (finding) Code: 248152002 System: `http://snomed.info/sct`
Direct Reference Code | Display: HIV 1 and 2 tests - Meaningful Use set Code: 75622-1 System: `http://loinc.org`
Dependencies
Dependency | Description: QICore model information Resource: http://hl7.org/fhir/Library/QICore-ModelInfo Canonical URL: `http://hl7.org/fhir/Library/QICore-ModelInfo`
Dependency | Description: Library SDE Resource: https://madie.cms.gov/Library/SupplementalDataElements|5.1.000 Canonical URL: `https://madie.cms.gov/Library/SupplementalDataElements|5.1.000`
Dependency | Description: Library FHIRHelpers Resource: https://madie.cms.gov/Library/FHIRHelpers|4.4.000 Canonical URL: `https://madie.cms.gov/Library/FHIRHelpers|4.4.000`
Dependency | Description: Library QICoreCommon Resource: https://madie.cms.gov/Library/QICoreCommon|4.0.000 Canonical URL: `https://madie.cms.gov/Library/QICoreCommon|4.0.000`
Data Requirements
Data Requirement | Type: Patient Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient Must Support Elements: extension, url, deceased
Data Requirement | Type: Observation Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab Must Support Elements: code, value, effective, status, status.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1056.50
Data Requirement | Type: Observation Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab Must Support Elements: code, value, effective, status, status.value Code Filter(s): Path: code Code(s): http://loinc.org#75622-1: 'HIV 1 and 2 tests - Meaningful Use set'
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, period, status, status.value Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, period, status, status.value Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, period, status, status.value Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, period, status, status.value Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, period, status, status.value Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
Data Requirement | Type: Coverage Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage Must Support Elements: type, period Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003
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