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promotes consistency across many of the other measures in the Star Ratings. Additionally, this change would align with the PQA’s recommendation that a denominator less than 30 members is an insufficient sample size for measurement purposes and could lead to unreliable or invalid results. We will implement this update to these measures for the 2025 measurement year. Section I. Display Measures Display measures on CMS.gov are published separately from the Star Ratings and include measures that are transitioned from inclusion in the Star Ratings, new or updated measures before inclusion into the Star Ratings, and informational-only measures. Organizations and sponsors have the opportunity to preview the data for their display measures prior to release on CMS.gov. The sections below focus on the current 2025 display measures and feedback CMS received on potential measure changes. Pharmacotherapy Management of Chronic Obstructive Pulmonary Disease (COPD) Exacerbation (Part C). Currently on the display page we include Pharmacotherapy Management of COPD Exacerbation - Systemic Corticosteroid and Pharmacotherapy Management of COPD Exacerbation – Bronchodilator. NCQA is exploring potential updates or replacements to this measure given recent clinical guideline updates. This effort may result in new measures for HEDIS if NCQA finds there are gaps in COPD measurement. Any updates or new measures would be available for the 2027 measurement year at the earliest. All commenters supported updates to align with current clinical guidelines. We have shared the comments with NCQA. Polypharmacy: Use of Multiple CNS-Active Medications in Older Adults (Poly-CNS) (Part D). The PQA updated the Poly-CNS measure specifications in the 2025 PQA Measure Manual to add the skeletal muscle relaxant class of medications to align with the 2023 updated American Geriatrics Society (AGS) Beers Criteria’s recommendation38 to avoid concurrent use of three or more CNS-active medications in older adults because of the increased risk of falls, fractures, and confusion. The 2023 AGS Beers Criteria for Potentially Clinically Important Drug-Drug Interactions That Should be Avoided in Older Adults (Table 5) to identify any combination of three or more CNS-active medications to avoid was revised to include skeletal muscle relaxants in the medication list. Therefore, the six new skeletal muscle relaxants that will be added to the Poly-CNS measure in 2025 are carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, and orphenadrine. CMS will align with the PQA measure specification updates and add the new skeletal muscle relaxant class of medications to the Poly-CNS measure for the 2025 measurement year (2027 display page). Most commenters supported adding the skeletal muscle relaxants as a new class of medications to the Poly-CNS measure. A couple of commenters opposed adding the skeletal muscle class to

38 American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults at https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18372.