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the Poly-CNS measure, and one commenter believed this would be a substantive change per the rules to update Star Ratings measures. As a reminder, as discussed in the April 2024 final rule,39 the Poly-CNS measure was not added to the Star Ratings and will remain on the display page. Therefore, since the Poly-CNS measure is not in the Star Ratings, measure specification updates are not subject to rulemaking, but CMS did announce this measure specification update in advance of the measurement year through the Advance Notice. Additionally, we received comments to expand the exclusion diagnoses and add significant mental health illnesses to the Poly-CNS measure since beneficiaries are in clinical care for these conditions and most likely receiving MTM. We appreciate this feedback and will forward the comments to the measure steward. The skeletal muscle class of medications will be added to the Poly-CNS measure for the 2025 measurement year. Use of Opioids at High Dosage in Persons Without Cancer (OHD)/ Initial Opioid Prescribing for Long Duration (IOP-LD) (Part D). The PQA also updated the OHD and IOP- LD measure specifications in the 2025 PQA Measure Manual to exclude beneficiaries with cancer-related pain treatment diagnosis during the measurement year to align with the 2022 CDC Guideline. CMS will incorporate this update beginning with the 2025 measurement year (2027 display page). Similar to the COB measure, commenters were supportive of updating the OHD and IOP-LD measures to exclude beneficiaries with cancer-related pain treatment. Likewise, we will apply the exclusion for the 2025 measurement year to align with the PQA measure specifications. Medication Adherence for Statins with Risk Adjustment (RA) (ADH-Statins RA)/ Medication Adherence for RAS Antagonists with RA (ADH-RAS RA)/ Medication Adherence for Diabetes Medications with RA (ADH-Diabetes RA)/ Antipsychotic Use in Persons with Dementia (APD)/ Antipsychotic Use in Persons with Dementia – for Long- Term Nursing Home Residents (APD-LTNH)/ OHD/ Poly-CNS/ IOP-LD/ Persistence to Basal Insulin (PST-INS)/ Medication Therapy Management (MTM) Program Completion Rate for Comprehensive Medication Review (CMR) (Part D). CMS excludes contracts with 30 or fewer enrolled members in the denominator from the display page; only contracts with 31 or more enrolled members receive a measure rate. The PQA recommends excluding contracts with fewer than 30 enrolled members from the measure rate calculations since it is an insufficient sample size for measurement purposes. Therefore, CMS plans to align with the PQA to exclude contracts with fewer than 30 enrolled members from the measure rate calculations, and contracts with 30 or more enrolled members will be included in the measure rate calculation starting with the 2025 measurement year (2027 display page).

39 Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Program for Contract Year 2024 - Remaining Provisions and Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (PACE) at https://www.govinfo.gov/content/pkg/FR-2024-04-23/pdf/2024-07105.pdf.