HIV Annual Retention in Care

Compare Versions of: "HIV Annual Retention in Care"

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Measure Information	2025 Performance Period	2026 Performance Period
Title	HIV Annual Retention in Care	HIV Annual Retention in Care
CMS eCQM ID	CMS1157v1	CMS1157v2
CBE ID*	Not Applicable	Not Applicable
MIPS Quality ID	340	340
Measure Steward	Health Resources & Services Administration	Health Resources & Services Administration
Description	Percentage of patients, regardless of age, with a diagnosis of Human Immunodeficiency Virus (HIV) during the first 240 days of the measurement period or before the measurement period who had at least two eligible encounters or at least one eligible encounter and one HIV viral load test... that were at least 90 days apart within the measurement period Show more > Percentage of patients, regardless of age, with a diagnosis of Human Immunodeficiency Virus (HIV) during the first 240 days of the measurement period or before the measurement period who had at least two eligible encounters or at least one eligible encounter and one HIV viral load test that were at least 90 days apart within the measurement period Show less	Percentage of patients, regardless of age, with a diagnosis of Human Immunodeficiency Virus (HIV) during the first 240 days of the measurement period or before the measurement period who had at least two eligible encounters or at least one eligible encounter and one HIV viral load test... that were at least 90 days apart within the measurement period Show more > Percentage of patients, regardless of age, with a diagnosis of Human Immunodeficiency Virus (HIV) during the first 240 days of the measurement period or before the measurement period who had at least two eligible encounters or at least one eligible encounter and one HIV viral load test that were at least 90 days apart within the measurement period Show less
Measure Scoring	Proportion measure	Proportion measure
Measure Type	Process	Process
Stratification	None	None
Risk Adjustment	None	None
Rationale	The HIV "continuum of care" is the process of HIV testing, linkage to HIV care, initiation of antiretroviral therapy (ART), adherence to treatment, retention in care, and virologic suppression (Gardner et al 2011). Poor retention in care is associated with lower rates of ART use... (Giordano et al 2003), delayed viral suppression (Crawford et al 2014), and increased risk of mortality (Giordano et al., 2007; Mugavero et al., 2009). This measure will help providers direct their attention and quality improvement efforts towards improving retention in care. Show more > The HIV "continuum of care" is the process of HIV testing, linkage to HIV care, initiation of antiretroviral therapy (ART), adherence to treatment, retention in care, and virologic suppression (Gardner et al 2011). Poor retention in care is associated with lower rates of ART use (Giordano et al 2003), delayed viral suppression (Crawford et al 2014), and increased risk of mortality (Giordano et al., 2007; Mugavero et al., 2009). This measure will help providers direct their attention and quality improvement efforts towards improving retention in care. Show less	The HIV "continuum of care" is the process of HIV testing, linkage to HIV care, initiation of antiretroviral therapy (ART), adherence to treatment, retention in care, and virologic suppression (Gardner et al 2011). Poor retention in care is associated with lower rates of ART use... (Giordano et al 2003), delayed viral suppression (Crawford et al 2014), and increased risk of mortality (Giordano et al., 2007; Mugavero et al., 2009). This measure will help providers direct their attention and quality improvement efforts towards improving retention in care. Show more > The HIV "continuum of care" is the process of HIV testing, linkage to HIV care, initiation of antiretroviral therapy (ART), adherence to treatment, retention in care, and virologic suppression (Gardner et al 2011). Poor retention in care is associated with lower rates of ART use (Giordano et al 2003), delayed viral suppression (Crawford et al 2014), and increased risk of mortality (Giordano et al., 2007; Mugavero et al., 2009). This measure will help providers direct their attention and quality improvement efforts towards improving retention in care. Show less
Clinical Recommendation Statement	"Retention in care should be routinely monitored. There are various ways to measure retention, including measures based on attended visits over a defined period of time (constancy measures) and measures based on missed visits. Both approaches are valid and independently predict survival.... Missed visits and a prolonged time since the last visit are relatively easy to measure and should trigger efforts to retain or re-engage a person in care. Constancy measures (e.g., at least two visits that are at least 90 days apart over 1 year or at least one visit every 6 months over the last 2 years) can be used as clinic quality assurance measures" (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. L-4). "Poor retention in HIV care is associated with greater risk of death. Poor retention is more common in people who use substances, have serious mental health problems, have unmet socioeconomic needs (e.g., housing, food, transportation), lack financial resources or health insurance, have schedules that complicate adherence, have been recently incarcerated, or face stigma. At the provider and health system level, low trust in providers and a poor patient-provider relationship have been associated with lower retention, as has lower satisfaction with the clinic experience. Availability of appointments and timeliness of appointments (i.e., long delay from the request for an appointment to the appointment's date) and scheduling convenience are also factors" (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. L-3). "Recommendation 2: Systematic monitoring of retention in HIV care is recommended for all patients (II A): Retention in care is associated with improved individual health outcomes, including HIV biomarker and clinical variables, and may reduce community-level viral burden, with implications for secondary prevention. Although monitoring retention is routinely recommended, specific details, such as retention measures to be used and desired visit frequency, vary among jurisdictions and programs and should be in harmony with national and international guidelines. Many retention measures (for example, visit adherence, gaps in care, and visits per interval of time) and data sources (for example, surveillance, medical records, and administrative databases) have been used and may be applied in accordance with local resources and standards of care. As with monitoring of linkage, integration of data sources may enhance monitoring of retention" (Thompson et al., 2012, p. 4). Show more > "Retention in care should be routinely monitored. There are various ways to measure retention, including measures based on attended visits over a defined period of time (constancy measures) and measures based on missed visits. Both approaches are valid and independently predict survival. Missed visits and a prolonged time since the last visit are relatively easy to measure and should trigger efforts to retain or re-engage a person in care. Constancy measures (e.g., at least two visits that are at least 90 days apart over 1 year or at least one visit every 6 months over the last 2 years) can be used as clinic quality assurance measures" (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. L-4). "Poor retention in HIV care is associated with greater risk of death. Poor retention is more common in people who use substances, have serious mental health problems, have unmet socioeconomic needs (e.g., housing, food, transportation), lack financial resources or health insurance, have schedules that complicate adherence, have been recently incarcerated, or face stigma. At the provider and health system level, low trust in providers and a poor patient-provider relationship have been associated with lower retention, as has lower satisfaction with the clinic experience. Availability of appointments and timeliness of appointments (i.e., long delay from the request for an appointment to the appointment's date) and scheduling convenience are also factors" (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. L-3). "Recommendation 2: Systematic monitoring of retention in HIV care is recommended for all patients (II A): Retention in care is associated with improved individual health outcomes, including HIV biomarker and clinical variables, and may reduce community-level viral burden, with implications for secondary prevention. Although monitoring retention is routinely recommended, specific details, such as retention measures to be used and desired visit frequency, vary among jurisdictions and programs and should be in harmony with national and international guidelines. Many retention measures (for example, visit adherence, gaps in care, and visits per interval of time) and data sources (for example, surveillance, medical records, and administrative databases) have been used and may be applied in accordance with local resources and standards of care. As with monitoring of linkage, integration of data sources may enhance monitoring of retention" (Thompson et al., 2012, p. 4). Show less	"Retention in care should be routinely monitored. There are various ways to measure retention, including measures based on attended visits over a defined period of time (constancy measures) and measures based on missed visits. Both approaches are valid and independently predict survival.... Missed visits and a prolonged time since the last visit are relatively easy to measure and should trigger efforts to retain or re-engage a person in care. Constancy measures (e.g., at least two visits that are at least 90 days apart over 1 year or at least one visit every 6 months over the last 2 years) can be used as clinic quality assurance measures" (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. L-4). "Poor retention in HIV care is associated with greater risk of death. Poor retention is more common in people who use substances, have serious mental health problems, have unmet socioeconomic needs (e.g., housing, food, transportation), lack financial resources or health insurance, have schedules that complicate adherence, have been recently incarcerated, or face stigma. At the provider and health system level, low trust in providers and a poor patient-provider relationship have been associated with lower retention, as has lower satisfaction with the clinic experience. Availability of appointments and timeliness of appointments (i.e., long delay from the request for an appointment to the appointment's date) and scheduling convenience are also factors" (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. L-3). "Recommendation 2: Systematic monitoring of retention in HIV care is recommended for all patients (II A): Retention in care is associated with improved individual health outcomes, including HIV biomarker and clinical variables, and may reduce community-level viral burden, with implications for secondary prevention. Although monitoring retention is routinely recommended, specific details, such as retention measures to be used and desired visit frequency, vary among jurisdictions and programs and should be in harmony with national and international guidelines. Many retention measures (for example, visit adherence, gaps in care, and visits per interval of time) and data sources (for example, surveillance, medical records, and administrative databases) have been used and may be applied in accordance with local resources and standards of care. As with monitoring of linkage, integration of data sources may enhance monitoring of retention" (Thompson et al., 2012, p. 4). Show more > "Retention in care should be routinely monitored. There are various ways to measure retention, including measures based on attended visits over a defined period of time (constancy measures) and measures based on missed visits. Both approaches are valid and independently predict survival. Missed visits and a prolonged time since the last visit are relatively easy to measure and should trigger efforts to retain or re-engage a person in care. Constancy measures (e.g., at least two visits that are at least 90 days apart over 1 year or at least one visit every 6 months over the last 2 years) can be used as clinic quality assurance measures" (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. L-4). "Poor retention in HIV care is associated with greater risk of death. Poor retention is more common in people who use substances, have serious mental health problems, have unmet socioeconomic needs (e.g., housing, food, transportation), lack financial resources or health insurance, have schedules that complicate adherence, have been recently incarcerated, or face stigma. At the provider and health system level, low trust in providers and a poor patient-provider relationship have been associated with lower retention, as has lower satisfaction with the clinic experience. Availability of appointments and timeliness of appointments (i.e., long delay from the request for an appointment to the appointment's date) and scheduling convenience are also factors" (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. L-3). "Recommendation 2: Systematic monitoring of retention in HIV care is recommended for all patients (II A): Retention in care is associated with improved individual health outcomes, including HIV biomarker and clinical variables, and may reduce community-level viral burden, with implications for secondary prevention. Although monitoring retention is routinely recommended, specific details, such as retention measures to be used and desired visit frequency, vary among jurisdictions and programs and should be in harmony with national and international guidelines. Many retention measures (for example, visit adherence, gaps in care, and visits per interval of time) and data sources (for example, surveillance, medical records, and administrative databases) have been used and may be applied in accordance with local resources and standards of care. As with monitoring of linkage, integration of data sources may enhance monitoring of retention" (Thompson et al., 2012, p. 4). Show less
Improvement Notation	Higher score equals better quality	Higher score equals better quality
Definition	To maintain consistency from year to year, this measure defines one month as equal to 30 days, three months as equal to 90 days and eight months as equal to 240 days. Only patients with an eligible encounter in the first eight months are included in this measure to allow for sufficient... time to complete a second eligible encounter or viral load laboratory within the 12-month measurement period and at least 90 days after the initial encounter. Show more > To maintain consistency from year to year, this measure defines one month as equal to 30 days, three months as equal to 90 days and eight months as equal to 240 days. Only patients with an eligible encounter in the first eight months are included in this measure to allow for sufficient time to complete a second eligible encounter or viral load laboratory within the 12-month measurement period and at least 90 days after the initial encounter. Show less	To maintain consistency from year to year, this measure defines one month as equal to 30 days, three months as equal to 90 days and eight months as equal to 240 days. Only patients with an eligible encounter in the first eight months are included in this measure to allow for sufficient... time to complete a second eligible encounter or viral load laboratory within the 12-month measurement period and at least 90 days after the initial encounter. Show more > To maintain consistency from year to year, this measure defines one month as equal to 30 days, three months as equal to 90 days and eight months as equal to 240 days. Only patients with an eligible encounter in the first eight months are included in this measure to allow for sufficient time to complete a second eligible encounter or viral load laboratory within the 12-month measurement period and at least 90 days after the initial encounter. Show less
Guidance	A patient would be included in the measure numerator if they have either two eligible encounters or one eligible encounter and one viral load test at least 90 days apart from each other. The encounter or encounters that cause a patient to be included in the numerator do not need to... include the encounter that caused the patient to be included in the denominator. This eCQM is a patient-based measure. This measure is to be submitted a minimum of once per measurement period for patients with a diagnosis of HIV during the first eight months of the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more > A patient would be included in the measure numerator if they have either two eligible encounters or one eligible encounter and one viral load test at least 90 days apart from each other. The encounter or encounters that cause a patient to be included in the numerator do not need to include the encounter that caused the patient to be included in the denominator. This eCQM is a patient-based measure. This measure is to be submitted a minimum of once per measurement period for patients with a diagnosis of HIV during the first eight months of the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less	A patient would be included in the measure numerator if they have either two eligible encounters or one eligible encounter and one viral load test at least 90 days apart from each other. The encounter or encounters that cause a patient to be included in the numerator do not need to... include the encounter that caused the patient to be included in the denominator. This eCQM is a patient-based measure. This measure is to be submitted a minimum of once per measurement period for patients with a diagnosis of HIV during the first eight months of the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more > A patient would be included in the measure numerator if they have either two eligible encounters or one eligible encounter and one viral load test at least 90 days apart from each other. The encounter or encounters that cause a patient to be included in the numerator do not need to include the encounter that caused the patient to be included in the denominator. This eCQM is a patient-based measure. This measure is to be submitted a minimum of once per measurement period for patients with a diagnosis of HIV during the first eight months of the measurement period. 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	All patients, regardless of age, with a diagnosis of HIV during the first 240 days of the measurement period or before the measurement period who had at least one eligible encounter during the first 240 days of the measurement period	All patients, regardless of age, with a diagnosis of HIV during the first 240 days of the measurement period or before the measurement period who had at least one eligible encounter during the first 240 days of the measurement period
Denominator	Equals Initial Population	Equals Initial Population
Denominator Exclusions	None	None
Numerator	Number of patients who had at least one eligible encounter and one HIV viral load test at least 90 days apart during the measurement period, or who had at least two eligible encounters at least 90 days apart during the measurement period	Number of patients who had at least one eligible encounter and one HIV viral load test at least 90 days apart during the measurement period, or who had at least two eligible encounters at least 90 days apart during the measurement period
Numerator Exclusions	Not Applicable	None
Denominator Exceptions	None	None
Telehealth Eligible	Yes	Yes
Next Version	CMS1157v2	No Version Available
Previous Version	No Version Available	CMS1157v1

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Specifications

Additional Resources for CMS1157v2

CMS1157-v2.0.000-TRN.xlsx

Header

TRN	Measure Section	Source of Change
Changed the 'eCQM Identifier (Measure Authoring Tool)' field name to 'CMS ID' based on tooling updates.	CMS ID	Standards/Technical Update
Updated the eCQM version number.	eCQM Version Number	Annual Update
Updated the generic measurement period from 'January 1, 20XX through December 31, 20XX' to specify 'January 1, 2026 through December 31, 2026' based on tooling updates.	Measurement Period	Standards/Technical Update
Updated copyright.	Copyright	Annual Update
Updated initial population statement to align with logic.	Initial Population	Measure Lead
Changed 'Numerator Exclusions' field to read 'None' instead of 'Not Applicable' when no exclusions are present.	Numerator Exclusions	Standards/Technical Update

Logic

TRN	Measure Section	Source of Change
Updated Measure Primary CQL Library Name from 'HIVRetention' to 'CMS1157HIVRetention' for alignment with the CQL Style Guide.	Definitions	Standards/Technical Update
Updated the version number of the Global Common Functions Library to v9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM.'	Definitions	Annual Update
Updated operator in definition 'Encounter During Measurement Period With HIV' to 'starts on or before day of start of' to increase precision.	Definitions	Measure Lead
Updated Measure Primary CQL Library Name from 'HIVRetention' to 'CMS1157HIVRetention' for alignment with the CQL Style Guide.	Functions	Standards/Technical Update
Updated the version number of the Global Common Functions Library to v9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM.'	Functions	Annual Update

Value Set

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

TRN	Measure Section	Source of Change
Replaced Value Set 'Face-to-Face Interaction' (2.16.840.1.113883.3.464.1003.101.12.1048) with 'Face to Face Interaction' (2.16.840.1.113762.1.4.1248.375).	Terminology	Annual Update
Value Set 'HIV' (2.16.840.1.113883.3.464.1003.120.12.1003): Deleted 6 ICD10CM codes (O98.711, O98.712, O98.713, O98.719, O98.72 O98.73) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update
Replaced Value Set 'HIV Viral Load' (2.16.840.1.113883.3.464.1003.120.12.1002) with 'HIV Viral Load Tests' (2.16.840.1.113762.1.4.1248.377).	Terminology	Annual Update
Value Set 'Office Visit' (2.16.840.1.113883.3.464.1003.101.12.1001): Added 1 SNOMEDCT code (185349003) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update
Replaced Value Set 'ONC Administrative Sex' (2.16.840.1.113762.1.4.1) with Value Set 'Federal Administrative Sex' (2.16.840.1.113762.1.4.1021.121) to represent Supplemental Data Element 'SDE Sex' based on revised standards.	Terminology	Standards/Technical Update
Value Set 'Telephone Visits' (2.16.840.1.113883.3.464.1003.101.12.1080): Added 8 CPT codes (98009, 98013, 98010, 98011, 98014, 98008, 98015, 98012) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update

Compare Versions of: "HIV Annual Retention in Care"

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