Hello, our ACO, participating at the individual, Group, APM Entity (All Models/Programs) level, is currently reviewing the MSSP patient roster and working with the participating organizations under our ACO to further understand the details of each eCQM and admin claims measures.

Can we get clarification on the following:

1. CMS165v12 Controlling High Blood Pressure: 
   a) How does the ACO calculate the exact date of the "measurement period"?
   b) Within denominator exclusions, how long in calendar or business days is "by the end of the measurement period"?
   c) How should a clinician define "an automated blood pressure monitor"? In the measure description, " It is the clinician's responsibility and discretion to confirm the automated blood pressure monitor or device used to obtain the blood pressure is considered acceptable and reliable and whether the blood pressure reading is considered accurate before documenting it in the patient's medical record." Does this mean it's based on the clinician's personal judgement?
2. CMS2v13 Preventive Care and Screening: Screening for Depression and Follow-Up Plan:
   a) For "Patients who have ever been diagnosed with bipolar disorder at any time prior to the qualifying encounter", is there a specific code that is associated with the specified bipolar disorder, or is this a general documentation within the EHR?
   b) For the numerator "Patients screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter", I want to confirm the tool mentioned is at the provider's discretion, and if a patient sees a referral for the follow up, the follow up behavioral health evaluation will need to mention the documented tool? For example, if primary care provider A uses the PHQ-2, patient fails, takes PHQ-9, the referred follow up will need to mention the PHQ-9 in their documentation? I ask because not all referral services are comprehensive when sending back their follow up notes, so I want to make sure our communication for documentation is very clear.
3. CMS122v12 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%):
   a) For denominator exclusion "Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period...", does "indication of frailty" require a specific evaluation tool/score/code or will this vary by how the provider documents for their patients?
4. The last topic I want to confirm is Promoting Interoperability is not required of our MSSP data submission to CMS, correct? I am under the impression that this is solely specific to MIPS. Thanks!