Functional Status Assessments for Heart Failure

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Measure Information	2023 Performance Period	2024 Performance Period	2025 Performance Period	2026 Performance Period
Title	Functional Status Assessments for Heart Failure	Functional Status Assessments for Heart Failure	Functional Status Assessments for Heart Failure	Functional Status Assessments for Heart Failure
CMS eCQM ID	CMS90v12	CMS90v13	CMS90v14	CMS90v15
CBE ID*	Not Applicable	Not Applicable	Not Applicable	Not Applicable
MIPS Quality ID	377	377	377	377
Measure Steward	Centers for Medicare & Medicaid Services (CMS)	Centers for Medicare & Medicaid Services (CMS)	Centers for Medicare & Medicaid Services (CMS)	Centers for Medicare & Medicaid Services (CMS)
Description	Percentage of patients 18 years of age and older with heart failure who completed initial and follow-up patient-reported functional status assessments	Percentage of patients 18 years of age and older with heart failure who completed initial and follow-up patient-reported functional status assessments	Percentage of patients 18 years of age and older with heart failure who completed initial and follow-up patient-reported functional status assessments	Percentage of patients 18 years of age and older with heart failure who completed initial and follow-up patient-reported functional status assessments
Measure Scoring	Proportion measure	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process	Process	Process	Process
Stratification	*See CMS90v12.html	None	None	None
Risk Adjustment	*See CMS90v12.html	None	None	None
Rationale	*See CMS90v12.html	Patients living with heart failure often have poor functional status and health-related quality of life, which declines as the disease progresses (Allen et al., 2012). In addition, their care is often complicated by multiple comorbidities. To assist in managing these complex patients,... the American College of Cardiology Foundation and American Heart Association recommend collecting initial and repeat assessments of a patient's function and ability to complete desired activities of daily living (Hunt et al., 2009). The American Heart Association has also released scientific statements emphasizing the collection of patient-reported health status (for example, functional limitations, symptom burden, quality of life) from heart failure patients as an important means of establishing a dynamic conversation between patient and provider regarding care goals and the patient's priorities (Allen et al., 2012; Rumsfeld et al., 2013). Show more > Patients living with heart failure often have poor functional status and health-related quality of life, which declines as the disease progresses (Allen et al., 2012). In addition, their care is often complicated by multiple comorbidities. To assist in managing these complex patients, the American College of Cardiology Foundation and American Heart Association recommend collecting initial and repeat assessments of a patient's function and ability to complete desired activities of daily living (Hunt et al., 2009). The American Heart Association has also released scientific statements emphasizing the collection of patient-reported health status (for example, functional limitations, symptom burden, quality of life) from heart failure patients as an important means of establishing a dynamic conversation between patient and provider regarding care goals and the patient's priorities (Allen et al., 2012; Rumsfeld et al., 2013). Show less	Patients living with heart failure often have poor functional status and health-related quality of life, which declines as the disease progresses (Allen et al., 2012). In addition, their care is often complicated by multiple comorbidities. To assist in managing these complex patients,... the American College of Cardiology Foundation and American Heart Association recommend collecting initial and repeat assessments of a patient's function and ability to complete desired activities of daily living (Hunt et al., 2009). The American Heart Association also released scientific statements emphasizing the collection of patient-reported health status (for example, functional limitations, symptom burden, quality of life) from heart failure patients as an important means of establishing a dynamic conversation between patient and provider regarding care goals and the patient's priorities (Allen et al., 2012; Rumsfeld et al., 2013). The most recent update to clinical guidelines by the American Heart Association, the American College of Cardiology, and the Heart Failure Society of America further emphasizes that better understanding of symptom burden and prognosis may improve the quality of treatment decisions. The guideline also indicates that routine assessment can facilitate population health management by identifying high-risk patients needing closer monitoring or referral to specialized centers and that patient-reported health status assessment increases the patient’s role in care, which can motivate initiation and uptake of medical therapy (Heidenreich et al., 2022). Show more > Patients living with heart failure often have poor functional status and health-related quality of life, which declines as the disease progresses (Allen et al., 2012). In addition, their care is often complicated by multiple comorbidities. To assist in managing these complex patients, the American College of Cardiology Foundation and American Heart Association recommend collecting initial and repeat assessments of a patient's function and ability to complete desired activities of daily living (Hunt et al., 2009). The American Heart Association also released scientific statements emphasizing the collection of patient-reported health status (for example, functional limitations, symptom burden, quality of life) from heart failure patients as an important means of establishing a dynamic conversation between patient and provider regarding care goals and the patient's priorities (Allen et al., 2012; Rumsfeld et al., 2013). The most recent update to clinical guidelines by the American Heart Association, the American College of Cardiology, and the Heart Failure Society of America further emphasizes that better understanding of symptom burden and prognosis may improve the quality of treatment decisions. The guideline also indicates that routine assessment can facilitate population health management by identifying high-risk patients needing closer monitoring or referral to specialized centers and that patient-reported health status assessment increases the patient’s role in care, which can motivate initiation and uptake of medical therapy (Heidenreich et al., 2022). Show less	Patients living with heart failure often have poor functional status and health-related quality of life, which declines as the disease progresses (Allen et al., 2012). In addition, their care is often complicated by multiple comorbidities. To assist in managing these complex patients,... the American College of Cardiology Foundation and American Heart Association recommend collecting initial and repeat assessments of a patient's function and ability to complete desired activities of daily living (Hunt et al., 2009). The American Heart Association also released scientific statements emphasizing the collection of patient-reported health status (for example, functional limitations, symptom burden, quality of life) from heart failure patients as an important means of establishing a dynamic conversation between patient and provider regarding care goals and the patient's priorities (Allen et al., 2012; Rumsfeld et al., 2013). The most recent update to clinical guidelines by the American Heart Association, the American College of Cardiology, and the Heart Failure Society of America further emphasizes that better understanding of symptom burden and prognosis may improve the quality of treatment decisions. The guideline also indicates that routine assessment can facilitate population health management by identifying high-risk patients needing closer monitoring or referral to specialized centers and that patient-reported health status assessment increases the patient’s role in care, which can motivate initiation and uptake of medical therapy (Heidenreich et al., 2022). Show more > Patients living with heart failure often have poor functional status and health-related quality of life, which declines as the disease progresses (Allen et al., 2012). In addition, their care is often complicated by multiple comorbidities. To assist in managing these complex patients, the American College of Cardiology Foundation and American Heart Association recommend collecting initial and repeat assessments of a patient's function and ability to complete desired activities of daily living (Hunt et al., 2009). The American Heart Association also released scientific statements emphasizing the collection of patient-reported health status (for example, functional limitations, symptom burden, quality of life) from heart failure patients as an important means of establishing a dynamic conversation between patient and provider regarding care goals and the patient's priorities (Allen et al., 2012; Rumsfeld et al., 2013). The most recent update to clinical guidelines by the American Heart Association, the American College of Cardiology, and the Heart Failure Society of America further emphasizes that better understanding of symptom burden and prognosis may improve the quality of treatment decisions. The guideline also indicates that routine assessment can facilitate population health management by identifying high-risk patients needing closer monitoring or referral to specialized centers and that patient-reported health status assessment increases the patient’s role in care, which can motivate initiation and uptake of medical therapy (Heidenreich et al., 2022). Show less
Clinical Recommendation Statement	*See CMS90v12.html	American College of Cardiology Foundation and American Heart Association (2013): While this guideline does not explicitly recommend the use of patient-reported functional status or quality of life assessments (such as the Kansas City Cardiomyopathy Questionnaire or Minnesota Living with... Heart Failure Questionnaire), it does “refer to meaningful survival as a state in which HRQOL [health-related quality of life] is satisfactory to the patient.” The guideline also includes quality of life assessments in its description of a detailed plan of care for patients with chronic heart failure. Show more > American College of Cardiology Foundation and American Heart Association (2013): While this guideline does not explicitly recommend the use of patient-reported functional status or quality of life assessments (such as the Kansas City Cardiomyopathy Questionnaire or Minnesota Living with Heart Failure Questionnaire), it does “refer to meaningful survival as a state in which HRQOL [health-related quality of life] is satisfactory to the patient.” The guideline also includes quality of life assessments in its description of a detailed plan of care for patients with chronic heart failure. Show less	The American Heart Association, the American College of Cardiology, and the Heart Failure Society of America (2022): This guideline provides patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure and specifically recommends assessing... patient-reported health status using a validated questionnaire to provide incremental information for patient functional status, symptom burden, and prognosis. Tools specifically recommended in the guideline are as follows: - The Kansas City Cardiomyopathy Questionnaire or, - The Minnesota Living with Heart Failure Questionnaire - PROMIS-Plus-HF [Patient Reported Outcomes Measurement Information System Plus-Heart Failure] Show more > The American Heart Association, the American College of Cardiology, and the Heart Failure Society of America (2022): This guideline provides patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure and specifically recommends assessing patient-reported health status using a validated questionnaire to provide incremental information for patient functional status, symptom burden, and prognosis. Tools specifically recommended in the guideline are as follows: - The Kansas City Cardiomyopathy Questionnaire or, - The Minnesota Living with Heart Failure Questionnaire - PROMIS-Plus-HF [Patient Reported Outcomes Measurement Information System Plus-Heart Failure] Show less	The American Heart Association, the American College of Cardiology, and the Heart Failure Society of America (2022): This guideline provides patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure and specifically recommends assessing... patient-reported health status using a validated questionnaire to provide incremental information for patient functional status, symptom burden, and prognosis. Tools specifically recommended in the guideline are as follows: - The Kansas City Cardiomyopathy Questionnaire or, - The Minnesota Living with Heart Failure Questionnaire - PROMIS-Plus-HF [Patient Reported Outcomes Measurement Information System Plus-Heart Failure] Show more > The American Heart Association, the American College of Cardiology, and the Heart Failure Society of America (2022): This guideline provides patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure and specifically recommends assessing patient-reported health status using a validated questionnaire to provide incremental information for patient functional status, symptom burden, and prognosis. Tools specifically recommended in the guideline are as follows: - The Kansas City Cardiomyopathy Questionnaire or, - The Minnesota Living with Heart Failure Questionnaire - PROMIS-Plus-HF [Patient Reported Outcomes Measurement Information System Plus-Heart Failure] Show less
Improvement Notation	A higher score indicates better quality	A higher score indicates better quality	A higher score indicates better quality	Higher score indicates better quality
Definition	*See CMS90v12.html	None	None	None
Guidance	Initial functional status assessment (FSA) and encounter: The initial FSA is an FSA that occurs within two weeks before or during an encounter, in the 180 days or more before the end of the measurement period. Follow-up FSA: The follow-up FSA must be completed at least 30 days but no more... than 180 days after the initial FSA. The same FSA instrument must be used for the initial and follow-up assessment. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more > Initial functional status assessment (FSA) and encounter: The initial FSA is an FSA that occurs within two weeks before or during an encounter, in the 180 days or more before the end of the measurement period. Follow-up FSA: The follow-up FSA must be completed at least 30 days but no more than 180 days after the initial FSA. The same FSA instrument must be used for the initial and follow-up assessment. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less	Initial functional status assessment (FSA) and encounter: The initial FSA is an FSA that occurs within two weeks before or during an encounter, in the 180 days or more before the end of the measurement period. Follow-up FSA: The follow-up FSA must be completed at least 30 days but no more... than 180 days after the initial FSA. The same FSA instrument must be used for the initial and follow-up assessment. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more > Initial functional status assessment (FSA) and encounter: The initial FSA is an FSA that occurs within two weeks before or during an encounter, in the 180 days or more before the end of the measurement period. Follow-up FSA: The follow-up FSA must be completed at least 30 days but no more than 180 days after the initial FSA. The same FSA instrument must be used for the initial and follow-up assessment. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less	Initial functional status assessment (FSA) and encounter: The initial FSA is an FSA that occurs within two weeks before or during an encounter, in the 180 days or more before the end of the measurement period. Follow-up FSA: The follow-up FSA must be completed at least 30 days but no more... than 180 days after the initial FSA. The same FSA instrument must be used for the initial and follow-up assessment. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more > Initial functional status assessment (FSA) and encounter: The initial FSA is an FSA that occurs within two weeks before or during an encounter, in the 180 days or more before the end of the measurement period. Follow-up FSA: The follow-up FSA must be completed at least 30 days but no more than 180 days after the initial FSA. The same FSA instrument must be used for the initial and follow-up assessment. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less	Initial functional status assessment (FSA) and encounter: The initial FSA is an FSA that occurs within two weeks before or during an encounter, in the 180 days or more before the end of the measurement period. Follow-up FSA: The follow-up FSA must be completed at least 30 days but no more... than 180 days after the initial FSA. The same FSA instrument must be used for the initial and follow-up assessment. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more > Initial functional status assessment (FSA) and encounter: The initial FSA is an FSA that occurs within two weeks before or during an encounter, in the 180 days or more before the end of the measurement period. Follow-up FSA: The follow-up FSA must be completed at least 30 days but no more than 180 days after the initial FSA. The same FSA instrument must be used for the initial and follow-up assessment. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less
Initial Population	Patients 18 years of age and older who had two outpatient encounters during the measurement period and a diagnosis of heart failure that starts any time before and continues into the measurement period.	Patients 18 years of age and older who had two outpatient encounters during the measurement period and a diagnosis of heart failure that starts any time before and continues into the measurement period.	Patients 18 years of age and older who had two outpatient encounters during the measurement period and a diagnosis of heart failure that starts any time before and continues into the measurement period	Patients 18 years of age and older who had two outpatient encounters during the measurement period and a diagnosis of heart failure that starts any time before and continues into the measurement period
Denominator	Equals Initial Population	Equals Initial Population	Equals Initial Population	Equals Initial Population
Denominator Exclusions	Exclude patients with severe cognitive impairment in any part of the measurement period. Exclude patients who are in hospice care for any part of the measurement period.	Exclude patients with severe cognitive impairment in any part of the measurement period. Exclude patients who are in hospice care for any part of the measurement period.	Exclude patients who are in hospice care for any part of the measurement period. Exclude patients with severe cognitive impairment in any part of the measurement period.	Exclude patients who are in hospice care or have a hospice care order documented during any part of the measurement period. Exclude patients with severe cognitive impairment in any part of the measurement period.
Numerator	Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12]; VR-36; Kansas City Cardiomyopathy Questionnaire [KCCQ]; KCCQ-12; Minnesota Living with Heart Failure Questionnaire [MLHFQ]; Patient-Reported Outcomes Measurement... Information System [PROMIS]-10 Global Health, PROMIS-29) present in the EHR within two weeks before or during the initial FSA encounter and results for the follow-up FSA at least 30 days but no more than 180 days after the initial FSA Show more > Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12]; VR-36; Kansas City Cardiomyopathy Questionnaire [KCCQ]; KCCQ-12; Minnesota Living with Heart Failure Questionnaire [MLHFQ]; Patient-Reported Outcomes Measurement Information System [PROMIS]-10 Global Health, PROMIS-29) present in the EHR within two weeks before or during the initial FSA encounter and results for the follow-up FSA at least 30 days but no more than 180 days after the initial FSA Show less	Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12]; VR-36; Kansas City Cardiomyopathy Questionnaire [KCCQ]; KCCQ-12; Minnesota Living with Heart Failure Questionnaire [MLHFQ]; Patient-Reported Outcomes Measurement... Information System [PROMIS]-10 Global Health; PROMIS-29) present in the EHR within two weeks before or during the initial FSA encounter and results for the follow-up FSA at least 30 days but no more than 180 days after the initial FSA Show more > Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12]; VR-36; Kansas City Cardiomyopathy Questionnaire [KCCQ]; KCCQ-12; Minnesota Living with Heart Failure Questionnaire [MLHFQ]; Patient-Reported Outcomes Measurement Information System [PROMIS]-10 Global Health; PROMIS-29) present in the EHR within two weeks before or during the initial FSA encounter and results for the follow-up FSA at least 30 days but no more than 180 days after the initial FSA Show less	Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12]; VR-36; Kansas City Cardiomyopathy Questionnaire [KCCQ]; KCCQ-12; Minnesota Living with Heart Failure Questionnaire [MLHFQ]; Patient-Reported Outcomes Measurement... Information System [PROMIS]-10 Global Health; PROMIS-29) present in the EHR within two weeks before or during the initial FSA encounter and results for the follow-up FSA at least 30 days but no more than 180 days after the initial FSA Show more > Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12]; VR-36; Kansas City Cardiomyopathy Questionnaire [KCCQ]; KCCQ-12; Minnesota Living with Heart Failure Questionnaire [MLHFQ]; Patient-Reported Outcomes Measurement Information System [PROMIS]-10 Global Health; PROMIS-29) present in the EHR within two weeks before or during the initial FSA encounter and results for the follow-up FSA at least 30 days but no more than 180 days after the initial FSA Show less	Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12]; VR-36; Kansas City Cardiomyopathy Questionnaire [KCCQ]; KCCQ-12; Minnesota Living with Heart Failure Questionnaire [MLHFQ]; Patient-Reported Outcomes Measurement... Information System [PROMIS]-10 Global Health; PROMIS-29) present in the EHR within two weeks before or during the initial FSA encounter and results for the follow-up FSA at least 30 days but no more than 180 days after the initial FSA Show more > Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12]; VR-36; Kansas City Cardiomyopathy Questionnaire [KCCQ]; KCCQ-12; Minnesota Living with Heart Failure Questionnaire [MLHFQ]; Patient-Reported Outcomes Measurement Information System [PROMIS]-10 Global Health; PROMIS-29) present in the EHR within two weeks before or during the initial FSA encounter and results for the follow-up FSA at least 30 days but no more than 180 days after the initial FSA Show less
Numerator Exclusions	Not Applicable	Not Applicable	Not Applicable	None
Denominator Exceptions	None	None	None	None
Telehealth Eligible	Yes	Yes	Yes	Yes
Next Version	CMS90v13	CMS90v14	CMS90v15	No Version Available
Previous Version	No Version Available	CMS90v12	CMS90v13	CMS90v14

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Specifications

Additional Resources for CMS90v12

CMS90v12-TRN.xlsx

Header

Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
Updated grammar and punctuation to improve readability.
Measure Section: Reference
Source of Change: Measure Lead
Updated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.
Measure Section: Guidance
Source of Change: Standards/Technical Update
Revised the Initial Population header language regarding the timing of the encounters and diagnosis to align with the current logic and to provide clarity.
Measure Section: Initial Population
Source of Change: Measure Lead
Revised the numerator language and guidance related to the timing of the initial functional status assessment to align with the current logic and to provide clarity.
Measure Section: Multiple Sections
Source of Change: Measure Lead

Logic

Updated the timing precision in the definitions from datetime to date by adding 'day of', 'date from', and/or function 'ToDateInterval' to align with the measure intent.
Measure Section: Definitions
Source of Change: Measure Lead
Added QDM datatypes Encounter, Performed and Assessment, Performed and associated logic to the Hospice.'Has Hospice Services' definition to provide additional approaches for identifying patients receiving hospice services.
Measure Section: Definitions
Source of Change: Measure Lead
Updated the version of the Quality Data Model (QDM) to 5.6 and Clinical Quality Language (CQL) to 1.5.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Replaced the Global.CalendarAgeInYearsAt function with the native CQL function AgeInYearsAt to take advantage of existing CQL features and increase human readability. As a result of this change, the LOINC code 21112-8 is no longer required and has been removed from the Terminology section of the human readable specification.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Updated the version number of the Hospice Library to v4.0.000.
Measure Section: Multiple Sections
Source of Change: Measure Lead

Value set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

Added direct reference code LOINC code (45755-6) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Replaced value set Hospice Care Ambulatory (2.16.840.1.113762.1.4.1108.15) with value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Hospice Encounter (2.16.840.1.113883.3.464.1003.1003) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Removed direct reference code LOINC code (21112-8) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (373066001) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead