Controlled on the most recent reading

**My Thought Process for Evaluating Member 40114 Against QM-CBP for 2026**

Alright, my primary task here is to determine if MEMBER 40114 meets the quality measure QM-CBP, which focuses on Blood Pressure Control in Hypertension, for the measurement year 2026. I need to be thorough and methodical in my evaluation, treating this as if I'm working through the logic myself.

First, I'll lay out the foundational information for the member: their date of birth (1971-09-03), sex (Female), and their enrolment period for 2026, which is continuous from January 1st to December 31st with no gaps. This continuous enrolment is crucial for eligibility.

Next, I'll review the member's encounters and any results they generated during the measurement year. I see a few key events:
*   An office visit on 2026-02-11, where hypertension (diagnosis I10) was noted, and a blood pressure reading of 148/92 was taken.
*   Another office visit on 2026-05-06, also with I10, and a BP reading of 142/88.
*   A subsequent office visit on 2026-09-22, again with I10, yielding a BP of 132/84.
*   Finally, an emergency department visit on 2026-11-30, with a diagnosis of R07.9 (chest pain, unspecified), and a BP reading of 156/96.

Crucially, I note that the member has no hospice, pregnancy, or dialysis listed, and they were alive at the end of the year. These are important exclusion criteria to keep in mind.

Now, I'll systematically evaluate the member against the quality measure's criteria, starting with the **Eligible Population**, which is essentially the denominator.

1.  **Age:** The member was born in 1971, making them 55 years old during 2026 (from their birthday in September onwards). This falls squarely within the 18-85 age requirement for this measure, so that's good.

2.  **Qualifying Event:** The measure requires an outpatient encounter with a diagnosis of hypertension (I10) occurring between January 1st, 2026, and June 30th, 2026. The office visit on 2026-02-11 with diagnosis I10 perfectly meets this requirement.

3.  **Enrolment:** As I noted earlier, the member had continuous enrolment for the entire year (2026-01-01 through 2026-12-31) with no gaps. This satisfies the enrolment criterion.

4.  **Exclusions:** I've already checked for hospice, pregnancy, and dialysis, and none apply. The member was also alive at year-end, so there are no exclusion events.

Therefore, MEMBER 40114 is **eligible** for the denominator of this measure.

Next, I move on to the **Numerator**, which defines the success criteria for blood pressure control. For this measure, I need to find the member's most recent *outpatient* blood pressure reading taken on or after the qualifying encounter (which was 2026-02-11) and on or before the end of the measurement year (2026-12-31).

Let's re-examine the readings and their context:
*   2026-02-11: Office visit (outpatient), BP 148/92. This is the qualifying encounter, but not necessarily the most recent.
*   2026-05-06: Office visit (outpatient), BP 142/88. This is a more recent outpatient reading.
*   2026-09-22: Office visit (outpatient), BP 132/84. This is the most recent outpatient reading I've seen so far.
*   2026-11-30: Emergency department visit (not an outpatient visit for the purpose of this reading), BP 156/96. The measure specifically excludes readings from emergency departments or inpatient admissions when identifying the most recent *outpatient* reading. Therefore, this reading must be skipped for numerator evaluation.

So, the most recent *valid outpatient* blood pressure reading is from 2026-09-22, which was 132/84.

Now, I need to check if this reading meets the blood pressure control thresholds for the measure:
*   Systolic pressure must be less than 140 mmHg. My reading is 132 mmHg, which is indeed < 140. **(Meets systolic threshold)**
*   Diastolic pressure must be less than 90 mmHg. My reading is 84 mmHg, which is < 90. **(Meets diastolic threshold)**

Since both the systolic and diastolic readings are below the defined thresholds, MEMBER 40114 **meets the numerator** criteria.

Therefore, the member is **compliant** with the QM-CBP measure for 2026.

Regarding the reason for compliance, I need to concisely explain *why* they are compliant, keeping in mind a tight word limit (under 30 words). The key points are: the most recent valid outpatient reading met the threshold, and the later emergency department reading was correctly excluded.

My initial thought for the reason was: "The most recent valid outpatient blood pressure reading of 132/84 on 2026-09-22 meets both systolic and diastolic thresholds, as the later ED reading is excluded." (27 words). This is good.

Let's try to refine it slightly for clarity and conciseness, ensuring it directly addresses the exclusion logic: "The member is compliant because the most recent eligible outpatient reading of 132/84 on 2026-09-22 is below threshold; the later emergency department reading is skipped." (26 words). This feels very precise and captures the essential elements.

Finally, I'll structure this into the requested JSON format:

```json
{
  "status": "compliant",
  "reason": "The member is compliant because the most recent eligible outpatient reading of 132/84 on 2026-09-22 is below threshold; the later emergency department reading is skipped."
}
```
I also double-checked if QM-FUM was relevant, as mentioned in the prompt. It's not; this is QM-CBP, so no additional keys are needed. The dates align, the logic for skipping the ED visit is correct, and the word count for the reason is well within limits. Everything looks sound.

**My Thought Process for Determining QM-CBP Compliance**

Alright, let's break down this member's status for the QM-CBP measure. My goal is to meticulously follow the specifications and arrive at the correct "compliant" or "non-compliant" determination, along with a precise reason.

First, I'm focusing on the **QM-CBP (Blood Pressure Control in Hypertension)** measure for the **2026 measurement year**.

The member in question is **Member 40114**, born on **1971-09-03**.

**1. Eligibility: Age**
I need to confirm their age as of **2026-12-31**.
Calculation: 2026 - 1971 = 55 years old.
The age range for this measure is 18-85. 55 falls squarely within that range, so they are **eligible** from an age perspective.

**2. Eligibility: Continuous Enrollment**
The requirement is continuous enrollment for the entire measurement year: **2026-01-01 through 2026-12-31**. The data explicitly states "continuous, no gaps." This member **meets** the continuous enrollment criterion.

**3. Eligibility: Denominator Event**
To be in the denominator, the member needs "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30."
I see the following:
*   A visit on **2026-02-11** with diagnosis I10. This falls within the Jan 1 - June 30 window.
*   A visit on **2026-05-06** with diagnosis I10. This also falls within the Jan 1 - June 30 window.
Since they have at least one such encounter, they **meet** the denominator event criterion.

**4. Eligibility: Exclusions**
Now, I must check for any reasons this member would be *excluded* from the measure, even if they meet the denominator criteria. The common exclusions I'm looking for are:
*   **E1 (ESRD/Dialysis):** The notes say "No mention in records." and "no dialysis". I can assume this means no exclusion here.
*   **E2 (Pregnancy):** I'm scanning for O00-O9A codes. The notes state "No O00-O9A codes." So, not excluded.
*   **E3 (Hospice/Palliative):** The notes indicate "No record" of this. Not excluded.
*   **E4 (Death):** The member is noted as "Alive at year end." Not excluded.

Since none of the exclusion criteria are met, this member is **not excluded**.

**5. Numerator: Identifying the Key Blood Pressure Reading**
This is where I need to be very precise. I need to identify "the most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31".

Let's list the relevant blood pressure readings I can find:
*   **2026-02-11:** BP 148/92 (Office visit, I10). This is an *outpatient* encounter and occurred *during* the qualifying window (Jan 1 - June 30).
*   **2026-05-06:** BP 142/88 (Office visit, I10). Another *outpatient* encounter within the qualifying window.
*   **2026-09-22:** BP 132/84 (Office visit, diagnosis I10). This is an *outpatient* reading.
*   **2026-11-30:** BP 156/96 (Emergency Department). The specification clearly states, "A reading taken in an emergency department... does not count and is skipped." So, I will **skip** this reading entirely when determining the "most recent".

Now, let's apply the criteria to find the specific reading:
*   The **qualifying hypertension encounters** (those establishing denominator eligibility) were on 2026-02-11 and 2026-05-06.
*   The **most recent *outpatient* reading** overall (after skipping the ED visit) is **2026-09-22** (132/84).
*   Is this reading (2026-09-22) **on or after** the date of the qualifying hypertension encounter (e.g., 2026-02-11)? Yes, September 22nd is after February 11th.
*   Is this reading **on or before 2026-12-31**? Yes, September 22nd is before December 31st.

Therefore, the **most recent outpatient blood pressure reading** to evaluate is **132/84 on 2026-09-22**.

**6. Numerator: Threshold Check**
The requirement is for the blood pressure to be "below 140 systolic AND below 90 diastolic."
*   Systolic: 132. Is 132 < 140? Yes.
*   Diastolic: 84. Is 84 < 90? Yes.

Since both conditions are met, the member's blood pressure reading is **controlled** according to the numerator criteria.

**7. Final Determination**
*   Eligible for denominator.
*   Not excluded.
*   Meets numerator criteria.

This means the member is **compliant**.

**8. Reason for Compliance**
I need to articulate *why* they are compliant concisely.
The key points are: the date of the reading, the reading itself, and how it meets the threshold.
The most recent *eligible* reading was on 2026-09-22, and it was 132/84. This value is indeed below the 140/90 threshold.

Thus, the final output for this member is:
*   **status**: "compliant"
*   **reason**: "The member is compliant because their most recent outpatient blood pressure reading on 2026-09-22 was 132/84, which is below the required 140/90 threshold."

**My Thought Process for QM-CBP Compliance Assessment**

Alright, let's break down this member's eligibility and compliance for the QM-CBP (Blood Pressure Control in Hypertension) measure. This is a straightforward one, but it's crucial to meticulously follow the specifications.

First, I've confirmed the measurement period is the entire calendar year of 2026, from January 1st to December 31st.

Next, I've identified the member, ID 40114, born in 1971. The first critical eligibility check is age. As of December 31, 2026, this member will be 55 years old (2026 - 1971 = 55). The measure's age range is 18 to 85. Since 55 falls squarely within that range, the member is eligible by age.

The second eligibility criterion is continuous enrollment. The member was continuously enrolled from January 1, 2026, through December 31, 2026. No gaps, so they are eligible for enrollment.

Now, to establish the denominator, I need to find at least one outpatient encounter with a hypertension diagnosis (ICD-10 code I10) occurring between January 1, 2026, and June 30, 2026. I see two such encounters: one on February 11, 2026, and another on May 6, 2026. Both are outpatient office visits with the I10 diagnosis. This means the member meets the denominator requirement.

Following that, I need to check for any exclusions. The measure lists End-Stage Renal Disease (ESRD) or dialysis, pregnancy, hospice or palliative care, and death. Based on the information available, there are no flags for ESRD, pregnancy, or hospice. The member is alive. Therefore, the member is not excluded from this measure.

With eligibility confirmed and no exclusions, I can proceed to the numerator. The numerator requires the most recent outpatient blood pressure reading taken *on or after the date of the qualifying hypertension encounter* and *on or before December 31, 2026*, and that this reading must be below 140 systolic AND below 90 diastolic.

The qualifying encounters occurred on February 11, 2026, and May 6, 2026. I need to find the most recent *outpatient* blood pressure reading after these dates. Let's review the available readings:
*   February 11, 2026: BP 148/92 (Outpatient)
*   May 6, 2026: BP 142/88 (Outpatient)
*   September 22, 2026: BP 132/84 (Outpatient)
*   November 30, 2026: BP 156/96 (Emergency Department - ED)

Crucially, the measure's specifications state that readings taken in an Emergency Department (ED) are skipped when identifying the most recent reading. Therefore, the ED visit on November 30th is disregarded for this purpose. This leaves the September 22, 2026 reading as the most recent *outpatient* blood pressure reading meeting the criteria.

The blood pressure reading on September 22, 2026, was 132/84. Now I apply the numerator criteria:
*   Systolic: Is 132 < 140? Yes.
*   Diastolic: Is 84 < 90? Yes.

Since both conditions are met, the member has achieved the numerator.

Therefore, the member is **compliant** for the QM-CBP measure.

Regarding the JSON output, I've noted that the `met_7_day` and `met_30_day` keys are specific to the QM-FUM measure and are *not* required for QM-CBP. So, I'll only include the "status" and "reason" keys.

The status is clearly "compliant". For the reason, I need a concise, single sentence under 30 words, explaining *why* they are compliant, highlighting the specific criterion or date. My final reason will be: "The most recent outpatient blood pressure reading on 2026-09-22 was 132/84, which is below the 140/90 threshold." This is 17 words and directly points to the date and the specific reading that secured compliance.

Let me work through this step by step.

Measure QM-CBP, measurement year 2026-01-01 through 2026-12-31.

Member 40114:
- DOB 1971-09-03. Age as of 2026-12-31: 2026 - 1971 = 55 (birthday Sept 3 occurs before Dec 31), so 55 years old. Within 18-85. ✓
- Enrolment: full year, no gaps. ✓
- Event: outpatient encounter with I10 on/between 2026-01-01 and 2026-06-30. 2026-02-11 office visit I10 — yes. ✓ (also 2026-05-06).

So member is in denominator.

Exclusions: E1 ESRD/dialysis — no. E2 pregnancy — no. E3 hospice/palliative — no. E4 died — no. Not excluded.

Numerator: most recent outpatient BP reading on or after the qualifying hypertension encounter (2026-02-11) and on or before 2026-12-31. ED readings don't count and are skipped.

Readings:
- 2026-02-11: 148/92 (outpatient, on the qualifying encounter date — "on or after the date of the qualifying hypertension encounter" — so it counts as a candidate reading)
- 2026-05-06: 142/88 (outpatient)
- 2026-09-22: 132/84 (outpatient)
- 2026-11-30: 156/96 (ED — skipped)

Most recent qualifying outpatient reading: 2026-09-22, 132/84. Below 140 systolic (132 < 140) ✓ and below 90 diastolic (84 < 90) ✓.

Status: compliant.

Reason: one sentence under 30 words naming the specific criterion or date. Something like: "Most recent qualifying outpatient BP reading (2026-09-22, 132/84) is below 140/90; the 2026-11-30 ED reading is excluded."

Word count check: "Most recent qualifying outpatient BP reading (2026-09-22, 132/84) is below 140/90; the 2026-11-30 ED reading is excluded." Let me count: Most(1) recent(2) qualifying(3) outpatient(4) BP(5) reading(6) (2026-09-22,(7) 132/84)(8) is(9) below(10) 140/90;(11) the(12) 2026-11-30(13) ED(14) reading(15) is(16) excluded(17). 17 words. Good.

Not QM-FUM, so no met_7_day/met_30_day keys. Only required keys: status, reason.

Output exactly one fenced JSON block, nothing else.

Here's my thought process for evaluating this member against the QM-CBP quality measure:

My primary objective is to determine the member's status – whether they are "compliant," "non_compliant," "excluded," or "not_eligible" – and provide a specific "reason" for that determination. I need to work through the quality measure's logic systematically.

**Step 1: Denominator - Am I looking at the right member?**

First and foremost, I need to confirm if this member is even supposed to be part of this measurement. This involves checking several criteria to see if they qualify for the denominator.

*   **Age:** The measure specifies an age range, typically 18-85 for many adult measures.
    *   The member's Date of Birth is 1971-09-03.
    *   The measurement year ends on 2026-12-31.
    *   Calculating their age at the end of the measurement year: 2026 minus 1971 is 55. Since their birthday is in September, they will be 55 by the end of 2026.
    *   The age range is 18-85.
    *   Since 55 falls squarely within this range, the age criterion is met.

*   **Qualifying Event:** The measure needs a specific event to identify the members who should be assessed.
    *   The requirement is for at least one outpatient encounter with a diagnosis of hypertension (ICD-10 code I10) occurring between January 1, 2026, and June 30, 2026.
    *   Looking at the member's encounters:
        *   On 2026-02-11, there was an office visit with diagnosis I10. This is an outpatient encounter and falls within the specified date range. This establishes eligibility.
        *   On 2026-05-06, there was another office visit with diagnosis I10, which also qualifies.
        *   On 2026-09-22, there was another office visit with I10. While this encounter *could* be used for the numerator (as it's after the qualifying event), it doesn't establish eligibility itself because it's after June 30th.
    *   The member clearly meets the qualifying event criterion.

*   **Continuous Enrollment:** The member needs to have been continuously enrolled throughout the measurement year.
    *   The record states: "Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps."
    *   This perfectly matches the requirement of full year enrollment with no significant gaps.

*   **Denominator Conclusion:** Based on age, the qualifying event, and continuous enrollment, this member is indeed in the denominator. Therefore, they are not "not_eligible."

**Step 2: Exclusions - Is there a reason to exclude this member entirely?**

Now, I need to check if any specific exclusion criteria apply. If any of these are met, the member is simply excluded from the measure, regardless of their clinical data.

*   **End-Stage Renal Disease (ESRD) or Dialysis:**
    *   The member's record explicitly states "No ... no dialysis."
    *   This exclusion does not apply.

*   **Pregnancy:**
    *   The record states "No pregnancy."
    *   This exclusion does not apply.

*   **Hospice or Palliative Care:**
    *   The record states "No hospice." While the measure might also include palliative care, the provided information suggests these specific conditions are absent. I'll proceed assuming the record is comprehensive for these exclusions.
    *   This exclusion does not apply.

*   **Death during the Measurement Year:**
    *   The record indicates "Member alive at year end."
    *   This exclusion does not apply.

*   **Exclusions Conclusion:** The member meets none of the exclusion criteria. Therefore, they are not "excluded."

**Step 3: Numerator - Did the member achieve the desired clinical outcome?**

Since the member is in the denominator and not excluded, I now need to evaluate their clinical performance against the numerator's requirements.

*   **Numerator Requirement:** The core of this measure is about blood pressure control. Specifically, the *most recent outpatient* blood pressure reading taken *on or after* the date of the qualifying hypertension encounter (which was 2026-02-11) and *on or before* the end of the measurement year (2026-12-31) must be below 140 systolic AND below 90 diastolic.

*   **Identifying the Most Recent *Qualifying* Reading:** This is the crucial part. I need to find the latest valid reading that meets the criteria.
    *   The qualifying period for the reading starts from 2026-02-11.
    *   Let's look at all available BP readings:
        *   **2026-02-11:** Office visit, BP 148/92. This is an outpatient reading, after the qualifying event.
        *   **2026-05-06:** Office visit, BP 142/88. This is an outpatient reading, after the qualifying event.
        *   **2026-09-22:** Office visit, BP 132/84. This is an outpatient reading, after the qualifying event.
        *   **2026-11-30:** Emergency department visit, BP 156/96. This is a reading taken in an emergency department.

    *   The measure specifically states: "A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading." This means the 2026-11-30 reading *must be ignored* for determining the "most recent" valid reading.

    *   Working backward from the end of the year, skipping the ED visit:
        *   The latest reading that is *not* from an ED or inpatient setting is the one on 2026-09-22. It's an office visit, which is outpatient.

*   **Evaluating the Most Recent *Valid* Reading:** The reading to assess is 132/84 on 2026-09-22.
    *   Thresholds: Systolic < 140 AND Diastolic < 90.
    *   Systolic check: 132 is indeed less than 140. This condition is met.
    *   Diastolic check: 84 is indeed less than 90. This condition is met.

*   **Numerator Conclusion:** Since both systolic and diastolic pressures are below the required thresholds on the most recent *valid outpatient* reading, the member meets the numerator criteria.

**Step 4: Final Determination**

*   The member is in the denominator.
*   The member is not excluded.
*   The member meets the numerator criteria.

Therefore, the final status is **"compliant."**

The reason for this status is clearly the blood pressure control: **"The member's most recent valid blood pressure reading of 132/84 on 2026-09-22 was below the 140/90 threshold, making them compliant."** The key nuance here is correctly identifying the "most recent valid reading" by excluding the ED encounter, which is critical for accurate quality measure assessment.

Alright, let's break down this member's record in relation to the QM-CBP quality measure.

First, I need to get a solid grasp on the member's demographic and enrollment information. I see we have Member ID 40114, born in 1971, female. Crucially, her enrollment spans the entire measurement year, 2026, without any breaks, so the continuous enrollment requirement is definitely met.

Next, I'm examining the encounters provided. There are four:
* February 11, 2026: An office visit for hypertension (I10) with a BP of 148/92.
* May 6, 2026: Another office visit for hypertension (I10) with a BP of 142/88.
* September 22, 2026: Another office visit for hypertension (I10) with a BP of 132/84.
* November 30, 2026: An emergency department visit for a non-specific chest pain symptom (R07.9) with a BP of 156/96.

Now, I'll systematically check for any exclusions that would disqualify this member. The record explicitly states no ESRD (N18.6), no dialysis (Z99.2), no pregnancy (O00-O9A), and no hospice or palliative care. The member is also alive at the end of the year. So, based on this information, no exclusions apply to this member.

Moving on to the denominator criteria – is this member eligible for the measure?
* **Age:** She was born in 1971. By December 31, 2026, she will be 55 (2026 - 1971 = 55). This falls perfectly within the 18-85 age range. Check.
* **Event:** She has an outpatient encounter with a confirmed hypertension diagnosis (I10) on February 11, 2026. This date is within the first half of the measurement year (January 1 to June 30, 2026). Check.
* **Continuous Enrollment:** As I noted earlier, her enrollment is continuous for the entire year. Check.
Therefore, this member clearly qualifies for the denominator.

Since no exclusions apply, the focus shifts entirely to the numerator criteria – did she achieve the target blood pressure control?
The goal is to find the most recent *outpatient* blood pressure reading taken *on or after* her qualifying encounter (February 11, 2026) and *on or before* the end of the measurement year (December 31, 2026).

Let's revisit those readings:
* February 11, 2026: Office visit, BP 148/92.
* May 6, 2026: Office visit, BP 142/88.
* September 22, 2026: Office visit, BP 132/84.
* November 30, 2026: **Emergency department visit, BP 156/96.**

Here's the critical part: the quality measure specifies that readings taken in an emergency department or during an inpatient admission do *not* count towards numerator compliance. This means I have to disregard the November 30th ED visit.

So, looking at the remaining *outpatient* readings (February 11, May 6, and September 22), the most recent one is on September 22, 2026. The blood pressure reading from that visit was 132/84.

Now, I compare this to the target: systolic less than 140 mmHg and diastolic less than 90 mmHg.
* Systolic: 132 mmHg is indeed less than 140 mmHg.
* Diastolic: 84 mmHg is indeed less than 90 mmHg.

Both components of the reading are below the required threshold. This means the member has successfully met the numerator criteria.

Therefore, my final determination is that this member is **compliant**. The reason is straightforward: her most recent qualifying outpatient blood pressure reading of 132/84, taken on September 22, 2026, was below the 140/90 mmHg threshold.

The JSON output should reflect this:
```json
{
  "status": "compliant",
  "reason": "The member's most recent qualifying blood pressure reading of 132/84 was below the 140/90 mmHg threshold."
}
```
The reason is concise, directly addresses the measure's criteria, and highlights the specific reading and threshold that confirm compliance. This looks like a solid, well-supported conclusion.

Alright, let's break down this member's record against the QM-CBP quality measure. My task is to assess their status: compliant, non-compliant, excluded, or not eligible, and then provide a clear reason for that determination.

First, I need to establish if this member is even in the running, meaning they belong in the denominator. This involves a few checks.

**1. Eligibility Check (The Denominator):**

*   **Age:** The member was born on September 3, 1971. The measurement year is 2026. So, by the end of 2026 (December 31), they'll be 55 years old (2026 - 1971). The age range for this measure is 18 to 85. Since 55 falls squarely within that range, that's a **pass**.
*   **Event:** The measure requires at least one outpatient encounter with a hypertension diagnosis (specifically ICD-10 code I10) between January 1, 2026, and June 30, 2026. Looking at the record, I see an "Office visit, diagnosis I10" on February 11, 2026. Perfect, that's an outpatient encounter with hypertension in the qualifying period. And there's another one on May 6, 2026, which also fits. So, the member **meets this criterion**.
*   **Continuous Enrolment:** The requirement is to be enrolled for the entire measurement year, with no more than one gap of up to 45 days. The member's record states: "Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps." This is exactly what's needed. **Another pass**.

*   **Conclusion on Eligibility:** Because the member meets all these criteria, they are definitely in the denominator. This means they won't be classified as "not_eligible." My next step is to see if they're excluded from the measure.

**2. Exclusion Check:**

I need to check for any conditions that would exclude this member from the numerator calculation.

*   **ESRD or Dialysis:** The record explicitly states "No dialysis" and there's no mention of ESRD. So, **not excluded** here.
*   **Pregnancy:** The record says "No pregnancy." **Not excluded.**
*   **Hospice or Palliative Care:** The record indicates "No hospice." I'll assume there's no palliative care either, as it's not listed. **Not excluded.**
*   **Died During Measurement Year:** The record confirms "Member alive at year end." **Not excluded.**

*   **Conclusion on Exclusions:** Since none of the exclusion criteria apply, this member will be either "compliant" or "non_compliant."

**3. Numerator Compliance Check:**

Now for the critical part: did they achieve the desired outcome? The requirement here is that their *most recent outpatient blood pressure reading*, taken on or after the date of their qualifying hypertension encounter (February 11, 2026) and by the end of the measurement year (December 31, 2026), must be below 140 systolic AND below 90 diastolic. Importantly, readings from the ED or inpatient settings don't count for this.

Let's look at the blood pressure readings chronologically after the qualifying February 11 encounter:

*   **February 11, 2026:** Office visit, BP 148/92. This is outpatient.
*   **May 6, 2026:** Office visit, BP 142/88. This is outpatient.
*   **September 22, 2026:** Office visit, BP 132/84. This is outpatient.
*   **November 30, 2026:** Emergency department visit, BP 156/96. **This reading is from the ED, so I must ignore it** as per the measure's rules.

The most recent *valid* outpatient blood pressure reading is from September 22, 2026, which was 132/84.

Now I compare this to the threshold:

*   Systolic: 132 is indeed less than 140. **Met.**
*   Diastolic: 84 is indeed less than 90. **Met.**

Both thresholds are met by this reading.

**4. Final Determination:**

*   **Status:** Based on the fact that the member is eligible, not excluded, and their most recent valid outpatient blood pressure reading met the target, the status is **"compliant."**
*   **Reason:** The member's most recent valid blood pressure reading, which was 132/84 on September 22, 2026, falls below the required threshold of 140/90 mmHg. The reading from the emergency department visit on November 30, 2026, was correctly excluded from consideration as per the measure's specifications.

So, the resulting JSON structure would be:

```json
{
  "status": "compliant",
  "reason": "The member's most recent valid blood pressure reading of 132/84 on 2026-09-22 was below the 140/90 mmHg threshold."
}
```

Everything seems to align perfectly with the measure's requirements. The logic is sound, and the exclusion of the ED visit was a key point to get right.

Let me evaluate this member against the QM-CBP measure specification.

**Step 1: Check eligible population (denominator)**

- Age: DOB 1971-09-03. As of 2026-12-31, age = 2026 - 1971 = 55 (birthday already passed in September). So age is 55, which is between 18 and 85. ✓
- Event: At least one outpatient encounter with hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30.
  - 2026-02-11: Office visit, I10. This is within the window. ✓
- Continuous enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓

So the member is in the denominator.

**Step 2: Check exclusions**

- E1: No dialysis, no ESRD mentioned. ✓ (not excluded)
- E2: No pregnancy. ✓ (not excluded)
- E3: No hospice or palliative care. ✓ (not excluded)
- E4: Member alive at year end. ✓ (not excluded)

No exclusions apply.

**Step 3: Check numerator**

The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31.

Qualifying hypertension encounter date: 2026-02-11 (the first one that establishes the event).

Wait, let me re-read: "on or after the date of the qualifying hypertension encounter." The qualifying encounter is the one that establishes the event - i.e., an outpatient encounter with I10 between 2026-01-01 and 2026-06-30. The first such encounter is 2026-02-11.

Actually, re-reading more carefully: "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30." So any of these encounters could be the qualifying one. But for the numerator, it says "on or after the date of the qualifying hypertension encounter." 

The encounters with I10:
- 2026-02-11: Office visit, I10, BP 148/92
- 2026-05-06: Office visit, I10, BP 142/88
- 2026-09-22: Office visit, I10, BP 132/84

The 2026-11-30 ED visit has diagnosis R07.9, not I10, and it's an ED visit so it doesn't count anyway.

Now, the "qualifying hypertension encounter" - I think this refers to any encounter that qualifies the member for the denominator. The first one is 2026-02-11. So BP readings on or after 2026-02-11 and on or before 2026-12-31.

The most recent outpatient BP reading:
- 2026-09-22: Office visit, BP 132/84. This is outpatient.
- 2026-11-30: ED visit - this is excluded ("A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading.")

So the most recent qualifying outpatient BP reading is 2026-09-22 with BP 132/84.

Is 132 < 140? Yes.
Is 84 < 90? Yes.

Both components are below the threshold. So the member meets the numerator.

**Status: compliant**

Reason: Most recent outpatient BP reading (132/84 on 2026-09-22) is below 140/90 threshold.

Let me evaluate this member against QM-CBP.

**Denominator eligibility:**
- Age: DOB 1971-09-03. As of 2026-12-31, age = 55. Within 18-85. ✓
- Event: At least one outpatient encounter with I10 on or between 2026-01-01 and 2026-06-30.
  - 2026-02-11: Office visit, I10. ✓
  - 2026-05-06: Office visit, I10. ✓
  - So event is met.
- Continuous enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓

Member is in the denominator.

**Exclusions:**
- E1: No dialysis, no ESRD. ✓ (not excluded)
- E2: No pregnancy. ✓
- E3: No hospice/palliative care. ✓
- E4: Alive at year end. ✓

No exclusions met.

**Numerator:**
Most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31.

Qualifying hypertension encounters (I10, outpatient, between 2026-01-01 and 2026-06-30):
- 2026-02-11
- 2026-05-06

The earliest qualifying encounter is 2026-02-11. The BP reading must be on or after the date of the qualifying hypertension encounter. Wait, let me re-read: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31."

So I need to find the most recent outpatient BP reading that is:
- On or after the date of the qualifying hypertension encounter
- On or before 2026-12-31
- Not in ED or inpatient

The qualifying encounters are on 2026-02-11 and 2026-05-06. The "qualifying hypertension encounter" - I think this means any of the qualifying encounters. Let me think about this more carefully.

Actually, re-reading: "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish the event."

So the qualifying encounter establishes the event. The numerator says "on or after the date of the qualifying hypertension encounter." If there are multiple qualifying encounters, which one? I think the standard interpretation is that the BP reading must be on or after the date of at least one qualifying encounter. Since the earliest qualifying encounter is 2026-02-11, any BP reading on or after 2026-02-11 would count.

Let me look at all BP readings:
- 2026-02-11: Office visit, I10. BP 148/92. (outpatient, on or after 2026-02-11) ✓
- 2026-05-06: Office visit, I10. BP 142/88. (outpatient, on or after 2026-02-11) ✓
- 2026-09-22: Office visit, I10. BP 132/84. (outpatient, on or after 2026-02-11) ✓
- 2026-11-30: Emergency department visit, R07.9. BP 156/96. (ED - does not count, skipped)

The most recent outpatient BP reading is 2026-09-22: BP 132/84.

132 < 140 ✓
84 < 90 ✓

Both components are below the threshold. So the numerator is met.

Status: compliant.

Reason: Most recent qualifying outpatient BP reading on 2026-09-22 was 132/84, both below thresholds.

Let me evaluate this member against the QM-CBP measure specification.

**Step 1: Check Eligible Population (Denominator)**

- **Age**: DOB is 1971-09-03. As of 2026-12-31, the member is 55 years old. 18-85 range: YES, eligible.
- **Event**: At least one outpatient encounter with hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30.
  - 2026-02-11: Office visit, I10 — YES, this qualifies.
  - 2026-05-06: Office visit, I10 — YES, this also qualifies.
  - Event criterion met.
- **Continuous enrolment**: Enrolled 2026-01-01 through 2026-12-31, continuous, no gaps. YES, eligible.

Member is in the denominator.

**Step 2: Check Exclusions**

- E1: No dialysis, no ESRD. Not excluded.
- E2: No pregnancy. Not excluded.
- E3: No hospice or palliative care. Not excluded.
- E4: Member alive at year end. Not excluded.

Member is NOT excluded.

**Step 3: Check Numerator**

The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31.

Qualifying hypertension encounters (I10, outpatient, between 2026-01-01 and 2026-06-30):
- 2026-02-11
- 2026-05-06

The earliest qualifying encounter is 2026-02-11. So I need to look for BP readings on or after 2026-02-11 and on or before 2026-12-31.

Wait, let me re-read: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31."

"the date of the qualifying hypertension encounter" — which one? There could be multiple. I think it means any qualifying hypertension encounter. So the BP reading must be on or after the date of at least one qualifying hypertension encounter.

Actually, re-reading more carefully: "on or after the date of the qualifying hypertension encounter" — this likely means on or after the date of any qualifying hypertension encounter that established the event. So the reading must be on or after the earliest qualifying encounter date? Or any qualifying encounter date?

Let me think about this differently. The measure says "the qualifying hypertension encounter" — this establishes the event. The event is established by having at least one outpatient encounter with I10 between 2026-01-01 and 2026-06-30. Once the event is established, we look for the most recent outpatient BP reading on or after the date of that qualifying encounter.

If there are multiple qualifying encounters, I think we use the earliest one to define "on or after." Or perhaps we use any of them. Let me re-read: "on or after the date of the qualifying hypertension encounter."

I think the intent is: the BP reading must be taken during or after a qualifying hypertension encounter. Since the first qualifying encounter is 2026-02-11, any BP reading on or after 2026-02-11 counts.

Let me list the BP readings:
- 2026-02-11: Office visit, I10, BP 148/92 — outpatient, on or after 2026-02-11 ✓
- 2026-05-06: Office visit, I10, BP 142/88 — outpatient, on or after 2026-02-11 ✓
- 2026-09-22: Office visit, I10, BP 132/84 — outpatient, on or after 2026-02-11 ✓
- 2026-11-30: Emergency department visit, R07.9, BP 156/96 — ED visit, does NOT count (skipped)

So the most recent qualifying outpatient BP reading is 2026-09-22: BP 132/84.

Check numerator criteria: below 140 systolic AND below 90 diastolic.
- Systolic: 132 < 140 ✓
- Diastolic: 84 < 90 ✓

Both are below the thresholds. The member meets the numerator.

**Conclusion**: The member is in the denominator, not excluded, and meets the numerator. Status: "compliant."

Reason: Most recent qualifying outpatient BP reading (2026-09-22) was 132/84, below 140/90 thresholds.

Let me work through this.

Member 40114, DOB 1971-09-03. As of 2026-12-31, age is 55 (born 1971, so 2026-1971 = 55, birthday September 3 already passed by Dec 31). Age 55, within 18-85. Eligible on age.

Event: outpatient encounter with hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. The 2026-02-11 office visit with I10 qualifies. Also 2026-05-06. The 2026-09-22 encounter is after 2026-06-30 so it doesn't establish the event, but it doesn't matter since earlier ones qualify.

Continuous enrolment: full year, no gaps. OK.

Denominator: yes.

Exclusions: E1 no (no ESRD/dialysis), E2 no pregnancy, E3 no hospice/palliative, E4 alive. No exclusions.

Numerator: most recent outpatient BP reading on or after the date of the qualifying hypertension encounter and on or before 2026-12-31, below 140 systolic AND below 90 diastolic. ED readings don't count.

Readings:
- 2026-02-11: 148/92 (office, outpatient) — after qualifying encounter date (same date, qualifies as on or after)
- 2026-05-06: 142/88 (outpatient)
- 2026-09-22: 132/84 (outpatient, office visit)
- 2026-11-30: 156/96 (ED — skipped)

Most recent qualifying reading counting: 2026-09-22, 132/84. 132 < 140 and 84 < 90. Both below. So numerator met.

Wait — the 2026-09-22 encounter is an office visit with diagnosis I10, but the encounter itself doesn't establish the event since it's after 2026-06-30. But the numerator just requires a BP reading from an outpatient (non-ED, non-inpatient) setting on or after the qualifying encounter date and on or before 2026-12-31. The 2026-09-22 office visit BP is an outpatient reading. So the most recent qualifying reading is 132/84 on 2026-09-22. That's below both thresholds.

Status: compliant.

Reason: The most recent outpatient BP (2026-09-22, 132/84) after the qualifying I10 encounter is below 140/90; ED reading on 2026-11-30 doesn't count. Keep under 30 words.

QM-FUM keys not needed — this is QM-CBP, not QM-FUM. So just status and reason.

Reason sentence: "Most recent outpatient BP reading on or after the qualifying 2026-02-01 encounter — 132/84 on 2026-09-22 — is below 140/90; the 2026-11-30 ED reading is excluded."

Wait, qualifying encounter was 2026-02-11. Let me write: "Numerator met: most recent qualifying outpatient BP is 132/84 on 2026-09-22 (after the 2026-02-11 I10 encounter), below 140/90; ED reading skipped."

Count words: Numerator(1) met(2): most(3) recent(4) qualifying(5) outpatient(6) BP(7) is(8) 132/84(9) on(10) 2026-09-22(11) (after(12) the(13) 2026-02-11(14) I10(15) encounter),(16) below(17) 140/90;(18) ED(19) reading(20) skipped(21). Under 30. Good.

Let me work through this measure step by step.

**Member 40114**, DOB 1971-09-03, Female.

**Eligible population (denominator):**
- Age: 18 through 85 as of 2026-12-31. DOB 1971-09-03 → age on 2026-12-31 = 55. Born 1971-09-03; on 2026-09-03 she turns 55. So as of 2026-12-31 she's 55. ✓
- Event: at least one outpatient encounter with hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. She has office visits with I10 on 2026-02-11 and 2026-05-06 — both in the window. ✓
- Continuous enrolment: enrolled full year 2026-01-01 through 2026-12-31, no gaps. ✓

So she's in the denominator.

**Exclusions:**
- E1: No ESRD/dialysis. Record says no dialysis. ✓ (not excluded)
- E2: No pregnancy. ✓
- E3: No hospice/palliative. ✓
- E4: Alive at year end. ✓

Not excluded.

**Numerator:**
The most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31, below 140 systolic AND below 90 diastolic.

Qualifying encounter: The most recent qualifying encounter is 2026-05-06 (I10 within window). Actually, "the date of the qualifying hypertension encounter" — which qualifying encounter? There are two that qualify (2026-02-11 and 2026-05-06). The readings considered must be on or after the date of a qualifying encounter. Let me consider readings:
- 2026-02-11: 148/92 (office visit, outpatient) — but wait, this is the same encounter date as a qualifying encounter. It's on or after the encounter date.
- 2026-05-06: 142/88
- 2026-09-22: 132/84 (outpatient)
- 2026-11-30: 156/96 — ED visit, does not count, skipped.

The most recent outpatient reading on or before 2026-12-31, on or after the qualifying encounter date: the ED reading is skipped. So the most recent qualifying reading is 2026-09-22: 132/84. That's below 140 AND below 90. So numerator met.

Wait — should I consider the "most recent qualifying encounter" only, or any qualifying encounter? If the qualifying encounter is taken as the latest one (2026-05-06), readings on or after 2026-05-06 include 2026-05-06 (142/88), 2026-09-22 (132/84). Most recent is 2026-09-22: 132/84 — controlled. Compliant either way.

Status: **compliant**.

Reason: Most recent qualifying outpatient BP (2026-09-22, 132/84) is below 140/90; ED reading excluded.

Keep reason under 30 words.

The extra keys met_7_day and met_30_day only apply to QM-FUM. This is QM-CBP, so I should NOT add those keys ("Items drawn from measure QM-FUM require two further keys" — this is QM-CBP, so no extra keys). The output contract says don't add keys not asked for.

JSON:
```json
{
  "status": "compliant",
  "reason": "Most recent outpatient BP after the qualifying I10 encounter was 132/84 on 2026-09-22, below 140/90; the 2026-11-30 ED reading is skipped."
}
```

Word count of reason: "Most recent outpatient BP after the qualifying I10 encounter was 132/84 on 2026-09-22, below 140/90; the 2026-11-30 ED reading is skipped." Let me count: Most(1) recent(2) outpatient(3) BP(4) after(5) the(6) qualifying(7) I10(8) encounter(9) was(10) 132/84(11) on(12) 2026-09-22(13), below(14) 140/90(15); the(16) 2026-11-30(17) ED(18) reading(19) is(20) skipped(21). Under 30 words. Good.

We need answer JSON only. Task: QM-CBP measure. Measurement year 2026-01-01 to 2026-12-31. Requires status, reason. Not QM-FUM so no met_7/30 keys.

We need place member against spec.

Member DOB 1971-09-03. Age as of 2026-12-31: 2026 - 1971 = 55, birthday Sep 3 passed (2026-12-31 after Sep 3), so age 55. Within 18-85. Good.

Event: at least one outpatient encounter with hypertension diagnosis I10 on/between 2026-01-01 and 2026-06-30. Encounters:
2026-02-11 Office visit dx I10 — outpatient? Office visit yes. Date within window. Qualifies.
2026-05-06 Office visit dx I10 also within window (also qualifies but first is enough).
Continuous enrolment: full 2026, no gaps. Good.

Denominator eligibility: yes. Not excluded? E1: ESRD/dialysis none. E2 pregnancy none. E3 hospice none. E4 died none. So denominator.

Numerator: most recent outpatient BP reading taken on or after date of qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both components below threshold. ED or inpatient reading doesn't count and is skipped when identifying most recent reading. If no qualifying reading, denominator and not numerator.

Qualifying encounter date: first (or any) qualifying hypertension encounter on or after? The numerator says "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31". Need determine "the qualifying hypertension encounter". There is at least one outpatient encounter with I10 between Jan 1 and Jun 30. The event that establishes denominator. Which date? Usually the qualifying encounter is the one that makes them eligible? Could be the earliest? It says "the date of the qualifying hypertension encounter". There is potentially multiple. Need parse: Event: at least one outpatient encounter with hypertension diagnosis (I10) on/between Jan 1 and Jun 30. An encounter after Jun 30 does not establish the event. Numerator: "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31". If multiple qualifying encounters within window, which date? Typically the denominator qualifying event is the earliest? Or the encounter that qualifies? Actually for measures like controlling high blood pressure, denominator is patients with hypertension diagnosis in first 6 months (or by some index date). The numerator looks at most recent BP during measurement year after the diagnosis. Wait HEDIS CBP: Denominator: members 18-85 with diagnosis of hypertension (essential hypertension) and at least one outpatient visit during the measurement year or year prior? Actually HEDIS: CBP: Denominator: adults 18-85 with a visit and diagnosis of hypertension. Numerator: most recent BP during measurement year is <140/90. But spec here is custom: event at least one outpatient encounter with I10 between Jan 1 and Jun 30. Numerator: most recent outpatient BP on or after the date of qualifying HTN encounter and <= Dec 31.

We have encounters:
- 2026-02-11: qualifying HTN encounter (I10). BP 148/92 (not controlled).
- 2026-05-06: office visit dx I10 (also qualifies as another encounter with I10 in window). BP 142/88. This is also a qualifying encounter within window. Date 2026-05-06.
- 2026-09-22: office visit dx I10. BP 132/84. This encounter is after Jun 30, so it does not establish the event. But it's an outpatient BP reading after the qualifying encounter(s) and before Dec 31. But note the BP reading on 2026-09-22 is at an encounter with dx I10 after Jun 30. Does that affect? Numerator just needs outpatient BP reading taken on/after date of qualifying hypertension encounter and before end of year. Is the 2026-09-22 reading after the qualifying encounter date? If date of qualifying encounter is the first one 2026-02-11, yes. If the last qualifying encounter in window is 2026-05-06, 2026-09-22 is after that too. So included. It is an outpatient BP reading (office visit). BP 132/84. Systolic 132 < 140, diastolic 84 < 90. Both below threshold. So numerator met (controlled). But wait there is also an ED visit on 2026-11-30 with BP 156/96, dx R07.9 (chest pain). ED visit is not outpatient? ED encounter: The numerator says reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying most recent reading. So when identifying most recent qualifying reading, skip ED and inpatient. The ED reading on 2026-11-30 would be skipped, so the most recent *qualifying* outpatient reading is the 2026-09-22 office visit 132/84? Wait, is there any outpatient reading after 2026-09-22 and before Dec 31? The ED visit is not outpatient qualifying? Actually ED visit is an encounter, but ED setting reading is excluded. The ED visit had dx R07.9, not I10. But regardless setting ED, reading skipped. So most recent outpatient non-ED/inpatient BP reading on/before Dec 31 after qualifying date is 2026-09-22 132/84. That is below thresholds. Numerator met. So status compliant.

Need be careful about "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31". The 2026-11-30 ED visit is not outpatient? Actually ED is not outpatient? In measures, outpatient includes ED? Usually outpatient includes ED? But spec explicitly says "A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading." So we skip it. The most recent *qualifying* reading is 2026-09-22 office visit 132/84, controlled.

But wait: The numerator says "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic." Do we consider all outpatient readings after qualifying encounter, including those at encounters that are not with I10? The 2026-09-22 had I10 and BP. The 2026-11-30 ED visit had R07.9, not I10. The reading is skipped anyway. So most recent outpatient (non-ED/inpatient) reading is 2026-09-22. Controlled.

Double-check: The 2026-05-06 reading was 142/88 (systolic >140) and 2026-02-11 148/92. Both not controlled. The 2026-09-22 is 132/84 controlled. So if most recent controlled, numerator met. Yes.

Are there any exclusions? No. Status compliant.

Reason: one sentence, under 30 words, naming specific criterion or date that decided it. Need name criterion/date. Something like: "Most recent qualifying outpatient BP after the 2026-02-11 hypertension encounter was 132/84 on 2026-09-22, below 140/90." Need check word count: Let's count: Most(1) recent(2) qualifying(3) outpatient(4) BP(5) after(6) the(7) 2026-02-11(8) hypertension(9) encounter(10) was(11) 132/84(12) on(13) 2026-09-22(14), below(15) 140/90(16). Under 30. Naming date and criterion. However, "qualifying hypertension encounter" could be 2026-02-11 or 2026-05-06. Does reason need to pick correct one? The earliest qualifying event date is 2026-02-11. The numerator looks at on/after the date of the qualifying hypertension encounter. If multiple, which one is "the qualifying hypertension encounter"? In measure logic, the denominator event is "at least one outpatient encounter with I10 between Jan and Jun". There can be multiple. The phrase "the qualifying hypertension encounter" singular maybe refers to the encounter that qualifies the member for denominator. If there are multiple, often the index date is the earliest? Or the last? Let's analyze.

Spec: "Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish the event." Then Numerator: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic."

If a member has multiple outpatient encounters with I10 in first half, all are qualifying encounters? "at least one" means any one qualifies. The event is satisfied. The "qualifying hypertension encounter" could be the one that established eligibility. Since the first one in time is what makes them eligible as of that date? In typical HEDIS event/diagnosis, if multiple visits, the earliest visit in the period is the index event? Actually for measures with a required diagnosis and visit in first 6 months, the "index event" is often the *last* visit in the eligibility window? Let's recall HEDIS CBP: It doesn't have a 6-month window; denominator: patients with hypertension who had a visit during the measurement year. Numerator: most recent BP <140/90. There's no "qualifying encounter date" concept. Here they invented: event is outpatient encounter with I10 in first 6 months. The numerator requires BP after that encounter. If they have multiple, the earliest? The phrase "the date of the qualifying hypertension encounter" – since event could be any of them, but the encounter that qualifies the member for denominator is the *first* one? Or the last one before Jun 30? Let's think.

Suppose a member has encounter Feb 11 and May 6. Both are with I10. The event "at least one" is satisfied. The "qualifying hypertension encounter" could be interpreted as the one that meets the event criteria. If they had only one, that's it. If multiple, each is a qualifying encounter. The most recent BP reading on or after "the date of the qualifying hypertension encounter" – if we take the earliest, any reading after Feb 11 counts, including May 6 and Sep 22. If we take the latest qualifying encounter (May 6), readings after May 6 are Sep 22 (and ED skipped). Still Sep 22 is after May 6. So regardless of whether qualifying encounter date is Feb 11 or May 6, the 2026-09-22 reading is after both. So the most recent qualifying reading is still Sep 22. The numerator result is same. Therefore no ambiguity matters for outcome. Good.

But we must ensure no reading after Sep 22 that is outpatient and counts. The only later encounter is Nov 30 ED, skipped. So most recent qualifying outpatient reading remains Sep 22. Controlled.

One nuance: The Sep 22 encounter is on 2026-09-22, with diagnosis I10. It's an outpatient office visit. It is after Jun 30, so it does not establish the event, but it is a BP reading. The numerator says "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter". It doesn't restrict readings to only those at hypertension encounters; just outpatient BP reading. So yes.

Another nuance: The Nov 30 ED visit had BP 156/96, which is uncontrolled, but because it is ED, it is skipped. The most recent *qualifying* reading is Sep 22 132/84. Correct.

Now check age: DOB 1971-09-03, as of 2026-12-31 age 55 (if born Sep 3 1971, on Dec 31 2026 they are 55, turning 56 in 2027). Within 18-85. Good.

Continuous enrolment: full year no gaps. Good.

Exclusions: none. So status compliant. Reason: mention date of controlled BP? Let's craft: "Most recent non-ED outpatient BP after the 2026-02-11 I10 encounter was 132/84 on 2026-09-22, below 140/90." Need include "non-ED" maybe because ED skipped. Under 30 words. Count: Most(1) recent(2) non-ED(3) outpatient(4) BP(5) after(6) the(7) 2026-02-11(8) I10(9) encounter(10) was(11) 132/84(12) on(13) 2026-09-22(14), below(15) 140/90(16). 16 words. It names specific criterion (numerator BP threshold) and date (2026-09-22 reading, and qualifying encounter date 2026-02-11). That decided compliant. Or we could say: "Controlled: most recent qualifying outpatient BP was 132/84 on 2026-09-22, after the 2026-02-11 hypertension encounter and below 140/90." Count: Controlled:(1) most(2) recent(3) qualifying(4) outpatient(5) BP(6) was(7) 132/84(8) on(9) 2026-09-22(10), after(11) the(12) 2026-02-11(13) hypertension(14) encounter(15) and(16) below(17) 140/90(18). Good.

Should we mention exclusions? Not needed. But reason should name criterion or date that decided it. The deciding criterion is numerator: most recent qualifying outpatient BP 132/84 on 2026-09-22 below 140/90, after ED skipped. Maybe mention ED skipped: "Skipping the 2026-11-30 ED reading, the most recent outpatient BP was 132/84 on 2026-09-22, below 140/90." Count: Skipping(1) the(2) 2026-11-30(3) ED(4) reading(5), the(6) most(7) recent(8) outpatient(9) BP(10) was(11) 132/84(12) on(13) 2026-09-22(14), below(15) 140/90(16). This names the ED exclusion and date. That is precise. It explains why the later uncontrolled ED BP doesn't make them non-compliant. It says "skipping the 2026-11-30 ED reading" which references the numerator skip rule. Good. Under 30 words. Let's ensure "ED" is clear. Maybe "emergency department" to be formal: "Skipping the 2026-11-30 emergency department reading, the most recent outpatient BP was 132/84 on 2026-09-22, below 140/90." Count: Skipping(1) the(2) 2026-11-30(3) emergency(4) department(5) reading(6), the(7) most(8) recent(9) outpatient(10) BP(11) was(12) 132/84(13) on(14) 2026-09-22(15), below(16) 140/90(17). Perfect. This names date of reading and criterion (below 140/90). It also implicitly references the qualifying encounter? It doesn't mention the hypertension encounter date. Is that required? The numerator requires reading on/after the qualifying encounter. The reason could mention that it was after the 2026-02-11 I10 encounter. Let's incorporate: "After the 2026-02-11 I10 encounter and skipping the 2026-11-30 ED reading, the last outpatient BP was 132/84 on 2026-09-22, below 140/90." Count: After(1) the(2) 2026-02-11(3) I10(4) encounter(5) and(6) skipping(7) the(8) 2026-11-30(9) ED(10) reading(11), the(12) last(13) outpatient(14) BP(15) was(16) 132/84(17) on(18) 2026-09-22(19), below(20) 140/90(21). Under 30. Good. This names both dates and the control threshold. I'll use this.

Wait: word "last" vs "most recent". Use "most recent". Let's draft final reason: "After the 2026-02-11 I10 encounter and skipping the 2026-11-30 ED reading, the most recent outpatient BP was 132/84 on 2026-09-22, below 140/90." Count words: After(1) the(2) 2026-02-11(3) I10(4) encounter(5) and(6) skipping(7) the(8) 2026-11-30(9) ED(10) reading(11), the(12) most(13) recent(14) outpatient(15) BP(16) was(17) 132/84(18) on(19) 2026-09-22(20), below(21) 140/90(22). 22 words. Good. The reason names specific criterion (below 140/90 numerator) and dates (2026-02-11 encounter, 2026-11-30 ED skipped, 2026-09-22 BP). Perfect.

Need output only fenced JSON code block. The JSON object requires keys "status" and "reason". No other keys. For QM-CBP, not QM-FUM, so no met_7_day etc. Ensure no extra keys.

Status string exactly "compliant". Reason string as above. Need ensure JSON escapes? The reason contains slashes in dates and BP? Dates have hyphens, BP has slash. In JSON string, slash doesn't need escaping, hyphen fine. But there is a "/" in 132/84 and 140/90. JSON allows "/" unescaped. No problem. Could escape as \/ but not necessary. Keep simple.

Let's double-check all logic thoroughly to avoid confidently wrong.

Let's walk through measure QM-CBP again:

Denominator:
- Age 18-85 as of 2026-12-31. DOB 1971-09-03 => Age 55. Yes.
- Event: at least one outpatient encounter with hypertension diagnosis I10 on/between 2026-01-01 and 2026-06-30. Encounters: 2026-02-11 Office visit dx I10 (outpatient, date in window) -> event met. Also 2026-05-06 Office visit dx I10 -> event met. Good.
- Continuous enrolment: enrolled full measurement year with no more than one gap up to 45 days. Enrolment 2026-01-01 through 2026-12-31, continuous, no gaps. Good.

Exclusions evaluated before numerator:
E1 ESRD/dialysis any time on/before 2026-12-31: record says no dialysis, no ESRD. None.
E2 Pregnancy O00-O9A during measurement year: none.
E3 Hospice/palliative: none.
E4 Died during measurement year: alive at year end. None.
So not excluded. Denominator confirmed.

Numerator:
- Most recent outpatient BP reading taken on/after date of qualifying HTN encounter and on/before 2026-12-31.
First, determine qualifying HTN encounter(s). Outpatient encounters with I10 in window: 2026-02-11 and 2026-05-06. Both are qualifying. The date of the qualifying encounter: if we pick first, 2026-02-11; if pick last, 2026-05-06. Readings on/after either and <=2026-12-31:
   - 2026-02-11 reading 148/92 (on the encounter date, after or on? "on or after" includes same day, but not last).
   - 2026-05-06 reading 142/88.
   - 2026-09-22 reading 132/84 (outpatient office visit; diagnosis I10 but after window; still a reading; it is after qualifying dates).
   - 2026-11-30 ED visit reading 156/96. ED reading does not count and is skipped when identifying most recent reading. Also it's not outpatient? But spec says ED reading skipped. So skip.
Thus among countable readings (outpatient, not ED/inpatient), the dates in order: Feb 11 (148/92), May 6 (142/88), Sep 22 (132/84). The most recent countable is Sep 22, 132/84. Is 132 < 140? Yes. 84 < 90? Yes. Both components below thresholds. So numerator met. Status compliant.

One more nuance: The ED visit on 2026-11-30 is an "Emergency department visit, diagnosis R07.9. BP 156/96." The numerator says "A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading." It says "skipped when identifying the most recent reading". That means if the most recent reading overall is ED, we skip it and look for the next most recent that is not ED/inpatient. The next most recent is Sep 22 office visit. Correct.

Another nuance: The Sep 22 encounter is an "Office visit, diagnosis I10." It is after 2026-06-30, so it does not establish the event. But it is still an outpatient BP reading. The numerator doesn't require the reading be at a hypertension encounter, just outpatient BP reading. So it's valid.

Could there be an issue that the Sep 22 reading is not "on or after the date of the qualifying hypertension encounter" if the qualifying encounter is considered the *last* one needed to satisfy "at least one" before Jun 30? The last qualifying encounter in window is May 6. Sep 22 is after May 6, so yes. If the qualifying encounter is considered the first (Feb 11), also yes. So no issue.

Could the 2026-05-06 reading 142/88 be considered? It is systolic 142 not <140, diastolic 88 <90. Not controlled. But it's not most recent, so irrelevant.

What if the measure intended the "qualifying hypertension encounter" to be the *latest* outpatient encounter with I10 during the measurement year? No, event must be in first half. So no.

What about "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter" – do we need to consider only readings at encounters with I10? The Sep 22 has I10, so even if so, qualifies. The Feb and May have I10. The Nov ED has R07.9. So doesn't matter.

Check age precisely: Born 1971-09-03. As of 2026-12-31, has she had birthday? 2026-09-03 is before 2026-12-31, so yes turned 55 on 2026-09-03 (2026-1971=55). Wait 2026-1971 = 55. Yes, age 55. Within 18-85. Good.

Continuous enrolment: full year no gaps. Good.

Result: compliant.

Now produce JSON. Ensure exactly one fenced JSON code block, nothing else. The code block should be ```json ... ```. Input says reply with exactly one fenced JSON code block and nothing else. No preamble. So final answer should be:

```json
{
  "status": "compliant",
  "reason": "After the 2026-02-11 I10 encounter and skipping the 2026-11-30 ED reading, the most recent outpatient BP was 132/84 on 2026-09-22, below 140/90."
}
```

Check word count of reason: Let's recount carefully with the exact string: "After the 2026-02-11 I10 encounter and skipping the 2026-11-30 ED reading, the most recent outpatient BP was 132/84 on 2026-09-22, below 140/90."

Tokens by spaces:
1 After
2 the
3 2026-02-11
4 I10
5 encounter

We need answer one fenced JSON only. Task family Quality Measure Logic. Given measure QM-CBP, not QM-FUM, so no met_7_day/met_30_day keys needed (only if QM-FUM). Required keys: status, reason. Need evaluate member against measure spec.

Let's parse member record:
Member 40114, DOB 1971-09-03. Measurement year 2026-01-01 through 2026-12-31.
Age as of 2026-12-31: DOB 1971-09-03. On 2026-12-31, age = 2026 - 1971 = 55 years if birthday passed (Sep 3). Yes as of Dec 31 2026, turned 55 on 2026-09-03. Age 55. Denominator age 18 through 85 inclusive. 55 qualifies.

Event: at least one outpatient encounter with hypertension diagnosis I10 on or between 2026-01-01 and 2026-06-30. Encounter after 2026-06-30 does not establish event. We have encounters:
- 2026-02-11 Office visit, diagnosis I10. BP 148/92. This is within Jan 1 - Jun 30, outpatient office visit with I10. Qualifying event date = 2026-02-11.
- 2026-05-06 Office visit, diagnosis I10. BP 142/88. Also within window, but qualifying encounter: there is at least one, so event established. The "date of the qualifying hypertension encounter" - there could be multiple. The measure says "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31". Need define qualifying hypertension encounter: The event is at least one outpatient encounter with I10 on/between dates. If multiple qualifying encounters, which date? It says "the date of the qualifying hypertension encounter". Usually the qualifying encounter is the one that makes member eligible; if multiple, the earliest? Actually numerator: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31". If there are multiple qualifying encounters in the window, "the qualifying hypertension encounter" might be the earliest one that establishes eligibility? Need inspect text: "Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish the event." It does not say "the earliest" or "most recent" qualifying encounter. It says the event is at least one. Then numerator refers to "the date of the qualifying hypertension encounter". Since the member had two qualifying encounters: 2026-02-11 and 2026-05-06. Which date is used? Usually in HEDIS-like measures, the "qualifying encounter" is the episode date; if multiple, the earliest? Wait, need be careful.

Actually the measure is synthetic: QM-CBP. Let's read carefully:

ELIGIBLE POPULATION (denominator)
  Age: 18 through 85 years as of 2026-12-31.
  Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish the event.
  Continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes the member from the denominator.

NUMERATOR
  The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both components must be below the threshold. A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading. If no qualifying reading exists, the member is in the denominator and not in the numerator.

Need identify qualifying hypertension encounter. There are two outpatient encounters with I10 in the event window: 2026-02-11 and 2026-05-06. The event is "at least one". The "qualifying hypertension encounter" could be the encounter that satisfies the event; if multiple, which one? Usually for hypertension measures (like HEDIS CBP), the Index Episode Start Date (IESD) is the earliest date of the qualifying encounter? Let's recall HEDIS Controlling Blood Pressure (CBP) measure: The event is an outpatient encounter with a diagnosis of hypertension during the first 6 months of the measurement year (or the year prior?). Actually HEDIS CBP: Denominator: Members 18-85 years of age who had a visit with a diagnosis of hypertension during the first 6 months of the measurement year (or the year prior to the measurement? Wait, HEDIS CBP uses "hypertension diagnosis" in the first 6 months of the measurement year? Let's recall: HEDIS CBP: "Members 18–85 years of age as of December 31 of the measurement year who had a visit with a diagnosis of hypertension (HTN) during the first six months of the measurement year (January 1–June 30)." The "Index Episode Start Date (IESD)" is the date of the earliest qualifying encounter? Actually IESD is the date of the first (earliest) qualifying encounter? Let's check: In HEDIS, for CBP, the event is an outpatient encounter with any diagnosis of hypertension. The IESD is the date of the encounter that qualifies the member for the measure. If a member has multiple visits, the IESD is the earliest date of service for a qualifying encounter during the intake period? Wait, I need precise.

HEDIS 2022 CBP: Eligible population: Age 18-85, continuous enrollment, no gap >45 days, event: at least one outpatient encounter (Outpatient Value Set) with a diagnosis of hypertension (Essential Hypertension Value Set) during the first 6 months of the measurement year (January 1-June 30). The measure looks for the most recent BP reading during the measurement year that occurs on or after the IESD (which is the date of the qualifying encounter? Actually "The Index Episode Start Date (IESD) is the date of service for the earliest qualifying encounter during the intake period." Let me recall: For measures with an "index event," the IESD is the date of the first (earliest) event that meets the event criteria. For example, in HEDIS, "The IESD is the date of the qualifying event. If multiple events meet criteria, the IESD is the earliest date." In CBP, the numerator requires a BP reading "on or after the IESD" (which is the date of the qualifying encounter). So if member had multiple hypertension encounters in Jan-Jun, the IESD would be the earliest qualifying encounter date (2026-02-11). But the numerator says "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter". If the earliest is 2026-02-11, then BP readings on or after that: 2026-02-11 (148/92), 2026-05-06 (142/88), 2026-09-22 (132/84). ED 2026-11-30 is skipped (ED). The most recent outpatient reading on or after 2026-02-11 is 2026-09-22, BP 132/84. That is below 140/90. So numerator met: systolic 132 <140, diastolic 84<90. So member would be compliant.

If instead the qualifying encounter was the latest in window (2026-05-06), readings on or after that date: 2026-05-06 (142/88), 2026-09-22 (132/84), skip ED 11-30. Most recent is 2026-09-22 132/84. Still below threshold. So either way, the most recent qualifying BP is 2026-09-22 132/84, because it's after both. ED reading 11-30 is skipped. Therefore numerator met regardless of which qualifying encounter date. Good.

Wait, is there any reading after 2026-09-22? There's 2026-11-30 ED visit BP 156/96. ED visit is excluded: "A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading." So we skip the 11-30 ED reading. There is no other reading after 09-22. So the most recent outpatient BP reading (non-ED, non-inpatient) on or after the qualifying encounter date is 2026-09-22 office visit BP 132/84. That is below 140/90. Thus numerator met.

Need check exclusions evaluated before numerator. Required exclusions E1-E4:
E1 ESRD (N18.6) or dialysis (Z99.2) any time on or before 2026-12-31. Record says "No hospice, no pregnancy, no dialysis." Does it say no ESRD? It says no dialysis. Need N18.6? It says "No hospice, no pregnancy, no dialysis. Member alive at year end." It doesn't explicitly say no ESRD, but says no dialysis. The encounter list doesn't list N18.6 diagnosis. The only diagnoses are I10 and R07.9. No ESRD code. So no E1. Also "no dialysis" means Z99.2 not present. E1 requires N18.6 or Z99.2. None present. E2 Pregnancy any O00-O9A during measurement year. Record says no pregnancy. E3 Hospice/palliative care any time during measurement year. Record says no hospice. E4 Died during measurement year. Member alive at year end, so not died. So no exclusions.

Continuous enrolment: Enrolment 2026-01-01 through 2026-12-31, continuous, no gaps. Full measurement year with no gaps (0 gaps). Satisfies (no more than one gap up to 45 days; here none). Age 55. Event established by 2026-02-11 (and 05-06) outpatient with I10 within window. So in denominator, not excluded. Numerator: met. Status = "compliant".

Now reason: one sentence, under 30 words, naming the specific criterion or date that decided it. Need craft reason. Something like: "Most recent qualifying outpatient BP on 2026-09-22 was 132/84, below 140/90; ED reading on 2026-11-30 is skipped." Check word count: Let's count: "Most recent qualifying outpatient BP on 2026-09-22 was 132/84, below 140/90; ED reading on 2026-11-30 is skipped." Words: Most(1) recent(2) qualifying(3) outpatient(4) BP(5) on(6) 2026-09-22(7) was(8) 132/84(9) below(10) 140/90(11) ED(12) reading(13) on(14) 2026-11-30(15) is(16) skipped(17). 17 words, under 30. It names the date that decided it: 2026-09-22 reading 132/84 controlled, and notes ED skipped. Or could say: "Met numerator: most recent outpatient BP after qualifying encounter was 132/84 on 2026-09-22, below 140/90; 2026-11-30 ED reading excluded." Count: Met(1) numerator(2) most(3) recent(4) outpatient(5) BP(6) after(7) qualifying(8) encounter(9) was(10) 132/84(11) on(12) 2026-09-22(13) below(14) 140/90(15) 2026-11-30(16) ED(17) reading(18) excluded(19). 19 words.

But reason should be "one sentence, under 30 words, naming the specific criterion or date that decided it". The criterion is numerator met because most recent outpatient BP reading (132/84 on 2026-09-22) is below 140/90, excluding ED 156/96. Need choose concise.

Could also say: "Compliant because the most recent non-ED outpatient BP, 132/84 on 2026-09-22, is below 140/90; the 2026-11-30 ED reading is skipped." Count: Compliant(1) because(2) the(3) most(4) recent(5) non-ED(6) outpatient(7) BP(8) 132/84(9) on(10) 2026-09-22(11) is(12) below(13) 140/90(14) the(15) 2026-11-30(16) ED(17) reading(18) is(19) skipped(20). 20 words.

Need ensure no extra keys. Required keys only status and reason. Since measure is QM-CBP not QM-FUM, do NOT include met_7_day/met_30_day. Output JSON object with exactly those two keys.

Check if any possibility of not_eligible? Age 55 yes. Enrollment continuous yes. Event yes. So denominator.

Check numerator details: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both components must be below the threshold. A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading. If no qualifying reading exists, the member is in the denominator and not in the numerator."

Wait: The BP reading must be an "outpatient blood pressure reading". All three office visits are outpatient (office visit) and have BP readings. 2026-02-11 (148/92) not below. 2026-05-06 (142/88): systolic 142 not below 140 (142 > 140), diastolic 88 below 90, but both components must be below; systolic fails, so not below threshold. 2026-09-22 (132/84): systolic 132 <140, diastolic 84<90, so qualifies and is below. The most recent outpatient BP reading is the one closest to 2026-12-31 among those taken on or after encounter date and not ED/inpatient. Since 2026-09-22 is later than 2026-05-06 and 2026-02-11. The 2026-11-30 is ED, skipped, so not counted. Therefore most recent counted reading is 2026-09-22, which is controlled. Numerator met. Good.

Need check "office visit" is outpatient. Yes. ED visit is not outpatient? Actually ED visit is not an outpatient encounter? The numerator says "outpatient blood pressure reading" and "A reading taken in an emergency department or on an inpatient admission does not count". The 2026-11-30 ED visit: diagnosis R07.9 (chest pain), BP 156/96. It's an ED visit, so reading does not count and is skipped. So most recent outpatient reading is 09-22.

One nuance: The event (qualifying encounter) is in first half: 2026-02-11 and 2026-05-06. Both are outpatient with I10. The latest is 2026-05-06. If the "qualifying hypertension encounter" for numerator is the 2026-05-06 encounter? The reading on 2026-05-06 itself is taken on the date of encounter and is after the earliest. But the most recent after 2026-05-06 is 2026-09-22. So same. Good.

Exclusions: The member had no ESRD/dialysis, no pregnancy, no hospice, alive. No exclusion.

Status = "compliant". reason string. Let's ensure spelling exactly as status values: "compliant", "non_compliant", "excluded", "not_eligible". Yes.

Now final answer: exactly one fenced JSON code block and nothing else. The block starts with ```json and ends with ```. Inside:

{
  "status": "compliant",
  "reason": "Compliant because the most recent counted outpatient BP, 132/84 on 2026-09-22, is below 140/90; the 2026-11-30 ED reading is skipped."
}

Check reason length: "Compliant because the most recent counted outpatient BP, 132/84 on 2026-09-22, is below 140/90; the 2026-11-30 ED reading is skipped." Count words: Compliant(1) because(2) the(3) most(4) recent(5) counted(6) outpatient(7) BP(8) 132/84(9) on(10) 2026-09-22(11) is(12) below(13) 140/90(14) the(15) 2026-11-30(16) ED(17) reading(18) is(19) skipped(20). Under 30. It names the specific date 2026-09-22 and criterion (below 140/90) and mentions ED skipped. Good. Maybe "counted" is clear. Alternatively "non-ED" instead of "counted". But "most recent outpatient BP" already excludes ED? Actually the numerator says most recent outpatient BP reading taken..., and ED reading does not count and is skipped when identifying most recent. So saying "most recent counted outpatient BP" is precise: among readings that count, the most recent is 132/84 on 2026-09-22. Good.

Wait, is 2026-09-22 an outpatient BP reading? Yes, office visit. It is after qualifying encounter date and before year end. Good.

Could there be an issue with the 2026-11-30 ED visit being the most recent encounter, but since it's ED, skipped, so the most recent outpatient reading is still 09-22. Yes.

Let's double-check diagnosis on 2026-09-22 office visit: It says "2026-09-22 Office visit, diagnosis I10. BP 132/84." So it is an outpatient encounter with hypertension diagnosis, but that's after event window, doesn't matter. It is a BP reading.

Now, one more nuance: The "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter". Are we sure the 2026-09-22 reading is "on or after" the date of the qualifying hypertension encounter if the qualifying encounter is 2026-02-11 or 2026-05-06? Yes, 09-22 is after both.

But what if the "qualifying hypertension encounter" is the latest encounter in the window, 2026-05-06, and the reading on 2026-05-06 is 142/88 (not controlled). The next reading is 09-22 132/84. The most recent after that is 09-22 (since 11-30 ED skipped). So controlled. Great.

Now ensure money/date format not relevant. Dates in reason are ISO 8601? The output contract says dates are ISO 8601. In prose reason, we should use ISO dates as given. We used 2026-09-22 and 2026-11-30. That's ISO. Good.

No currency.

Need final answer exactly fenced JSON block, no preamble. Must not output anything else. Let's produce:

```json
{
  "status": "compliant",
  "reason": "Compliant because the most recent counted outpatient BP, 132/84 on 2026-09-22, is below 140/90; the 2026-11-30 ED reading is skipped."
}
```

Check if reason is one sentence: It has a semicolon, but it's one sentence. Under 30 words. Good.

One more check: The instructions say "Reply with exactly one fenced JSON code block and nothing else. No preamble, no commentary before or after, no second code block." So include the triple backticks. The content type is json. Use valid JSON. The keys required are status and reason only. We have that.

Let's ensure no trailing comma. Valid JSON.

Let's also think if status could be non_compliant because the most recent BP reading (inclusive of ED?) is 156/96 on 11-30, which is not below, but ED is skipped. The measure explicitly says ED reading does not count and is skipped when identifying the most recent reading. So we must skip it. So compliant. Good.

What about "outpatient blood pressure reading" - is an office visit BP an outpatient reading? Yes.

Everything fine.

We need answer only JSON block. Need analyze measure QM-CBP. Member 40114 DOB 1971-09-03. Measurement year 2026. Age as of 2026-12-31: born 1971-09-03, on 2026-12-31 age = 55? Let's calculate: 2026 - 1971 = 55, birthday Sep 3 already passed in 2026, so age 55. Within 18 through 85. Good.

Event: at least one outpatient encounter with hypertension diagnosis I10 on or between 2026-01-01 and 2026-06-30. Encounters: 2026-02-11 office visit dx I10 (yes, outpatient? "Office visit" qualifies as outpatient encounter). Also 2026-05-06 within range. So qualifying encounter(s). The earliest? Need identify qualifying hypertension encounter date? Spec says "on or after the date of the qualifying hypertension encounter". There may be multiple qualifying encounters. Typically the qualifying event is the hypertension encounter during the first 6 months; the numerator looks at most recent outpatient BP reading taken on or after date of the qualifying hypertension encounter and on or before 2026-12-31. If multiple qualifying encounters, we need determine which date? The phrase "the date of the qualifying hypertension encounter" singular. The event is at least one outpatient encounter with I10 in first half. Since there are two (2026-02-11 and 2026-05-06), we must choose? Let's parse: Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish the event. So any such encounter qualifies for denominator. Numerator: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic." It says the qualifying hypertension encounter (the one that established denominator). If there are multiple, which one is "the" qualifying? Usually the earliest? Actually typical HEDIS Controlling High Blood Pressure: denominator is patients with hypertension diagnosis in first 6 months (or two visits? Wait measure: CBP? Let's think). For HEDIS CBP (Controlling High Blood Pressure), denominator: adults 18-85 with diagnosis of hypertension in first 6 months of measurement year, and at least one visit? Actually numerator: most recent BP during measurement year is <140/90. Exclusions: ESRD, pregnancy, hospice/palliative, deceased. But this spec is a custom QM-CBP. It says event: at least one outpatient encounter with I10 between Jan and Jun. So any encounter in that window establishes. It doesn't say earliest or latest. To determine BP reading on or after date of the qualifying hypertension encounter. If there are multiple qualifying encounters, the most recent BP reading after the latest qualifying encounter? Or after any qualifying encounter? Let's examine.

If we take earliest qualifying encounter date = 2026-02-11. Then qualifying readings on or after 2026-02-11 and on/before 2026-12-31, most recent outpatient reading (skip ED/inpatient). Outpatient visits: 2026-05-06 BP 142/88 (outpatient office), 2026-09-22 BP 132/84 (outpatient office). The ED visit 2026-11-30 BP 156/96 is ED, does not count and is skipped. So most recent outpatient reading is 2026-09-22 BP 132/84. Is it <140 systolic and <90 diastolic? Yes, 132 < 140 and 84 < 90. So numerator met. Status compliant. If we take latest qualifying encounter date = 2026-05-06, then readings on or after 2026-05-06 include 2026-05-06 itself BP 142/88, 2026-09-22 132/84 (most recent), ED skipped. Most recent outpatient is still 2026-09-22 132/84, controlled. So regardless, numerator met. Good.

Check exclusions: E1 ESRD/dialysis none. E2 pregnancy none. E3 hospice/palliative none. E4 died? member alive at year end. So no exclusion. Enrolment continuous full year, no gaps. Denominator eligible: age 55, event yes, continuous yes. Numerator met.

Status: "compliant". Reason: one sentence under 30 words naming specific criterion or date that decided it. Need craft reason. Something like: "Eligible by age 55 and I10 encounter on 2026-02-11; most recent outpatient BP on 2026-09-22 was 132/84, below 140/90." Check word count: Eligible(1) by(2) age(3) 55(4) and(5) I10(6) encounter(7) on(8) 2026-02-11;(9) most(10) recent(11) outpatient(12) BP(13) on(14) 2026-09-22(15) was(16) 132/84,(17) below(18) 140/90.(19) Under 30. Good. Need maybe mention no exclusion? Not needed? It says naming the specific criterion or date that decided it. The deciding criterion is most recent outpatient BP reading on 2026-09-22 (skipped ED) below threshold. Also eligible population. We can name both.

Need ensure JSON keys: For QM-CBP, required keys are "status" and "reason" only (since items drawn from QM-FUM require extra keys; this is QM-CBP, so no met_7_day etc). The task says Required JSON keys: "status", "reason". Then: Items drawn from measure QM-FUM require two further keys... This is QM-CBP, so do not include met_7_day/met_30_day. Do not add keys not asked for. So JSON object: {"status":"compliant","reason":"..."}. Need use JSON null? Not needed.

Let's verify details:

Age: DOB 1971-09-03. As of 2026-12-31: 2026-1971=55, birthday Sep 3 passed. Age 55, within 18-85 inclusive? "18 through 85 years" yes. On 2026-12-31 age is 55. Good.

Event: at least one outpatient encounter with hypertension diagnosis I10 on or between 2026-01-01 and 2026-06-30. 2026-02-11 office visit dx I10. Office visit is outpatient. Yes. 2026-05-06 office visit dx I10 also. 2026-09-22 is after 2026-06-30, so cannot establish event, but it's an outpatient visit with I10 after the event; it can be used for numerator? Numerator: most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31. The qualifying encounter date is in first half (Feb 11 or May 6). The Sep 22 reading is on or after that date and before end. Yes. It is an outpatient visit (office visit) with diagnosis I10. BP 132/84. That is most recent outpatient reading, because later encounter is ED on 2026-11-30, which is emergency department visit, BP does not count and is skipped. So most recent qualifying is 2026-09-22.

Check threshold: "below 140 systolic AND below 90 diastolic." 132 < 140 true. 84 < 90 true. Both below. Compliant.

Exclusions: none. No ESRD (N18.6/Z99.2), no pregnancy (O00-O9A), no hospice/palliative, alive. Also member not excluded.

Continuous enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. Good.

Thus status compliant.

Need reason string: "Eligible by age 55 and I10 encounter on 2026-02-11; most recent outpatient BP on 2026-09-22 was 132/84, below 140/90." Wait need ensure "below 140/90" meaning below 140 systolic and below 90 diastolic. Yes. Could say "under 140/90". Let's check word count: "Eligible by age 55 and I10 encounter on 2026-02-11; most recent outpatient BP on 2026-09-22 was 132/84, under 140/90." Count: Eligible1 by2 age3 55 4 and5 I10 6 encounter7 on8 2026-02-11;9 most10 recent11 outpatient12 BP13 on14 2026-09-22 15 was16 132/84,17 under18 140/90.19. Good. Must be one sentence, under 30 words. It is a sentence (has semicolon, but one sentence). Use period at end? Yes.

Need output exactly one fenced JSON code block and nothing else. No preamble. So:

```json
{
  "status": "compliant",
  "reason": "Eligible by age 55 and I10 encounter on 2026-02-11; most recent outpatient BP on 2026-09-22 was 132/84, under 140/90."
}
```

Check JSON formatting: keys in double quotes. Use boolean? No.

Let's double-check if there is any nuance about "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter". If the qualifying hypertension encounter is 2026-05-06 (the latest in the first half), then 2026-05-06 BP 142/88. The most recent outpatient reading after that date and before year end is still 2026-09-22 (132/84). Wait, is 2026-09-22 after 2026-05-06? Yes. Is 2026-09-22 encounter an outpatient encounter? It says "Office visit, diagnosis I10. BP 132/84." It is an office visit, outpatient. Good. The ED 2026-11-30 is after, but ED is skipped. So most recent outpatient after all is Sep 22. Good.

But consider if the most recent outpatient reading is taken "on or after the date of the qualifying hypertension encounter". Does the 2026-09-22 encounter itself have a hypertension diagnosis I10, but it's after 2026-06-30. Does it establish a new qualifying encounter? No, event must be on/between Jan 1 and Jun 30. But for numerator, "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter". The reading is from an encounter with I10 after Jun 30, but that doesn't matter; it's just an outpatient BP reading. It doesn't need to be a hypertension encounter; it just needs to be an outpatient BP reading on/after the qualifying encounter date. Yes.

Could the 2026-09-22 office visit be considered an encounter after 2026-06-30 that "does not establish the event". Right, it cannot establish denominator event, but it's still an outpatient encounter/reading. The numerator just says outpatient blood pressure reading. The office visit is outpatient. Good.

Potential issue: The numerator says "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading." So when identifying most recent reading, we skip ED. The 2026-11-30 ED visit is skipped. So most recent is 2026-09-22. Yes.

Exclusions: E4 died during measurement year. Member alive at year end, so not died during measurement year. Good.

Everything settled, no pend/insufficient.

Need final answer. Ensure no trailing text. Use fenced code block with json. Nothing else. Done.

We need to apply measure QM-CBP — Blood Pressure Control in Hypertension. Measurement year 2026-01-01 through 2026-12-31.

We need to determine status: compliant, non_compliant, excluded, not_eligible.

First, denominator eligibility:
- Age: 18 through 85 years as of 2026-12-31. DOB 1971-09-03. Age as of 2026-12-31: 2026-1971 = 55, but month/day: 12/31 vs 09/03, so age 55. Between 18 and 85 inclusive? Yes, 55 is within 18-85. So age eligible.
- Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. The member has:
  - 2026-02-11 Office visit, diagnosis I10. This is within Jan 1 - June 30. So event satisfied.
- Continuous enrollment: enrolled full measurement year with no more than one gap up to 45 days. Enrollment: 2026-01-01 through 2026-12-31, continuous, no gaps. So continuous enrollment satisfied.

Thus member is in denominator (eligible). Not "not_eligible".

Next, exclusions:
E1. End stage renal disease (N18.6) or dependence on renal dialysis (Z99.2) any time on or before 2026-12-31. Record says no dialysis. No mention of N18.6. So no exclusion.
E2. Pregnancy (any O00-O9A code) during measurement year. Record says no pregnancy. So no.
E3. Hospice or palliative care any time during measurement year. No hospice. So no.
E4. Died during measurement year. Alive at year end. So no.

Thus member is not excluded. Status will be either compliant or non_compliant.

Numerator:
"The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both components must be below the threshold. A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading. If no qualifying reading exists, the member is in the denominator and not in the numerator."

We need to identify the qualifying hypertension encounter. The event is at least one outpatient encounter with I10 between Jan 1 and June 30. The member has two such encounters: 2026-02-11 and 2026-05-06. Both are outpatient office visits with I10. The "qualifying hypertension encounter" is presumably the earliest? Or any? The numerator says "taken on or after the date of the qualifying hypertension encounter". Since there could be multiple, but the numerator says "the date of the qualifying hypertension encounter" (singular). However, usually in these measures, any qualifying encounter establishes the denominator, and then the numerator looks at the most recent outpatient BP reading on or after that encounter date (i.e., after the first qualifying event? Or after any qualifying event?). The wording: "taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31". If there are multiple qualifying encounters, which date is used? The measure text says "the date of the qualifying hypertension encounter". That implies there is a single encounter that qualifies. But the denominator event is "at least one outpatient encounter". If there are multiple, perhaps the earliest? Or perhaps any, and you consider the most recent BP after the earliest? Let's parse carefully.

In HEDIS-like measures, for CBP (Controlling High Blood Pressure), the denominator is based on a diagnosis of hypertension during the measurement year or prior year, etc. But here the spec is custom. It says: "Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30." Then numerator: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic."

The phrase "qualifying hypertension encounter" likely refers to the encounter that made the member enter the denominator. Since the event is defined as at least one encounter, the member qualifies. But which encounter date is used for the numerator? Usually, if there are multiple, you would use the first one? Or the one that is used to identify the member? The spec doesn't explicitly say "first" or "earliest". However, the numerator wants the most recent BP after that date. If we use the earliest qualifying encounter (2026-02-11), then any BP after that counts. If we use the latest qualifying encounter (2026-05-06), then only BP after 2026-05-06 counts. Which is intended?

Let's think: If the measure wants to see if BP is controlled after diagnosis, it might want any reading after the first qualifying encounter in the first half of the year. The member's most recent outpatient BP reading before year end is on 2026-09-22 (BP 132/84). The emergency department reading on 2026-11-30 is skipped because it's ED. So the most recent outpatient BP reading after the qualifying encounter(s) is 2026-09-22 BP 132/84.

But we must check if there is any restriction that the reading must be after the specific qualifying encounter. If the qualifying encounter is the earliest one (2026-02-11), then 2026-09-22 is after it. If it's the latest one (2026-05-06), also after. So either way, 2026-09-22 qualifies.

But what if a member had a qualifying encounter on 2026-06-30 and a BP on 2026-03-01? That BP would be before the qualifying encounter and wouldn't count. In this case, the earliest encounter is 2026-02-11, and the BPs after that are 2026-05-06 (142/88), 2026-09-22 (132/84), and the ED one is skipped. The most recent outpatient BP is 2026-09-22. Is it below 140 systolic and below 90 diastolic? 132 < 140 and 84 < 90. Yes. So numerator is met.

Thus status = "compliant".

Reason: Must be one sentence, under 30 words, naming the specific criterion or date that decided it.

We need to say why compliant: Most recent outpatient BP 132/84 on 2026-09-22 meets control thresholds. Or: "Most recent outpatient blood pressure after the qualifying encounter was 132/84 on 2026-09-22." Let's count words: Most(1) recent(2) outpatient(3) blood(4) pressure(5) after(6) the(7) qualifying(8) encounter(9) was(10) 132/84(11) on(12) 2026-09-22(13). meets(14) control(15) thresholds(16). That's 16 words. Good.

But maybe simpler: "Outpatient BP 132/84 on 2026-09-22 is below 140/90." That's 9 words.

Wait, we need to name the specific criterion or date that decided it. The deciding factor is the most recent outpatient BP reading meeting the thresholds. So: "Most recent outpatient BP of 132/84 on 2026-09-22 is below 140 systolic and 90 diastolic." Count: Most(1) recent(2) outpatient(3) BP(4) of(5) 132/84(6) on(7) 2026-09-22(8) is(9) below(10) 140(11) systolic(12) and(13) 90(14) diastolic(15). 15 words. Good.

We need to ensure no extra keys. The task says: Required JSON keys: "status", "reason". No other keys asked. Wait, the prompt says: "Items drawn from measure QM-FUM require two further keys: met_7_day, met_30_day. For a member who is excluded or not_eligible under QM-FUM, report both as false." But this measure is QM-CBP. So we only need status and reason. Do not add extra keys.

Thus final JSON:

{
  "status": "compliant",
  "reason": "Most recent outpatient BP of 132/84 on 2026-09-22 is below 140 systolic and 90 diastolic."
}

Double-check: Is there any nuance about the BP reading on 2026-05-06 being 142/88? That's not the most recent outpatient one. The most recent outpatient one before year end is 2026-09-22. The ED reading is skipped. So correct.

Check exclusions: none. Denominator: yes.

One more nuance: The event requires "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30." The member has two. Good.

Age: DOB 1971-09-03. As of 2026-12-31, age = 55 years, 3 months, 28 days. So 55. Good.

Enrollment: continuous, no gaps.

Thus compliant.

Ensure JSON formatting: exactly one fenced JSON code block, no extra text.

Let's write it.

 We need to apply measure QM-CBP. Let's examine the member record.

Member 40114, DOB 1971-09-03. As of 2026-12-31, age = 2026 - 1971 = 55, turning 55 on 2026-09-03. So age is between 18 and 85 inclusive. Good.

Enrollment: 2026-01-01 through 2026-12-31, continuous, no gaps. So continuous enrollment criterion met.

Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. The record shows:
- 2026-02-11 Office visit, dx I10. BP 148/92. This is an outpatient encounter with I10 within the first half of the year.
- 2026-05-06 Office visit, dx I10. BP 142/88. Also outpatient within first half.
So event criterion met.

Required exclusions:
E1. End stage renal disease or dialysis: No.
E2. Pregnancy: No.
E3. Hospice or palliative care: No.
E4. Died during measurement year: Alive at year end.
None apply. So not excluded.

Numerator: The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both components must be below threshold. A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading. If no qualifying reading exists, denominator not numerator.

We have qualifying hypertension encounter dates: 2026-02-11 and 2026-05-06. After each, there are subsequent outpatient BP readings.

List of BP readings:
- 2026-02-11 Office visit: BP 148/92. This is on the qualifying encounter date (on or after date of qualifying encounter). It's outpatient. Systolic 148 (not below 140), diastolic 92 (not below 90). So not numerator-compliant, but it exists.
- 2026-05-06 Office visit: BP 142/88. Outpatient. Systolic 142 (not below 140), diastolic 88 (below 90). Not both below.
- 2026-09-22 Office visit: BP 132/84. Outpatient. Systolic 132 (<140), diastolic 84 (<90). Both below. This is after the qualifying encounter (May 6) and on or before 2026-12-31.
- 2026-11-30 ED visit: BP 156/96. ED visit does not count and is skipped.

Identify the most recent outpatient BP reading taken on or after the qualifying hypertension encounter and on or before 2026-12-31. The most recent outpatient reading is 2026-09-22 (BP 132/84). The ED reading is skipped. So the most recent qualifying reading is 132/84, which meets the threshold (<140 and <90). Therefore numerator is met.

Wait, let's double-check: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic." The qualifying hypertension encounter date is the first qualifying event? Or any qualifying encounter? In standard HEDIS, it's "on or after the date of the qualifying encounter" meaning any qualifying encounter in the first half. So we look at all outpatient BP readings on or after the first qualifying encounter (Feb 11) and on or before 12/31. The most recent outpatient reading is 9/22, which is 132/84. That meets.

But some measure logic might define the denominator event as the earliest qualifying encounter or just any qualifying encounter. The numerator looks at readings after the qualifying encounter. Usually it's after the date of the first qualifying encounter in the intake period. But the exact wording: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31..." This implies there is a specific qualifying hypertension encounter that established the event. Since any encounter on or between 2026-01-01 and 2026-06-30 with I10 qualifies, and we have two. Typically, the "qualifying encounter" is the one that is used to satisfy the event requirement. If there are multiple, the measure spec often means the earliest? Or any? HEDIS usually says "the date of the first qualifying encounter in the measurement year"? But this spec says "the date of the qualifying hypertension encounter" singular. In many measure specs, any qualifying encounter works, and the numerator includes readings on or after the date of that encounter. Actually in HEDIS CBP, the numerator looks for a BP reading during the measurement year that is <140/90. They usually don't tie it to after the encounter. But this synthetic spec says "taken on or after the date of the qualifying hypertension encounter". So we must follow this. If there are two qualifying encounters, which date is used? The spec doesn't explicitly say if it's the first, the last, or any. Let's think.

The denominator event is "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30." So any such encounter qualifies the member. The numerator says "taken on or after the date of the qualifying hypertension encounter". Since the denominator is satisfied by any encounter, and there are two, we need to pick the relevant one. Usually, in measure specs with this wording, the "qualifying encounter" refers to the encounter that satisfies the event. If there are multiple, you might consider each? But the numerator says "the most recent ... taken on or after the date of the qualifying hypertension encounter". If we use the earliest (Feb 11), then the most recent outpatient BP reading on or after Feb 11 is 9/22 (132/84). If we use the latest qualifying encounter (May 6), then the most recent on or after May 6 is still 9/22. So either way, the most recent qualifying reading is 9/22. The 11/30 ED is skipped. So the answer is the same. Good. No ambiguity affects the result.

Therefore status is "compliant". Reason: cite the specific criterion or date that decided it. Under 30 words. Something like "Most recent outpatient BP on 2026-09-22 was 132/84, below threshold." Or "Outpatient BP 132/84 on 2026-09-22 met control threshold."

We need to ensure the reason is one sentence and under 30 words.

Let's count: "Outpatient BP 132/84 on 2026-09-22 was below threshold." That's 9 words? Let's count: Outpatient(1) BP(2) 132/84(3) on(4) 2026-09-22(5) was(6) below(7) threshold(8). 8 words. Good.

Or "Most recent qualifying outpatient BP on 2026-09-22 was 132/84." (10 words). Also good.

Let's check if any exclusion could be triggered. E1 none. E2 none. E3 none. E4 none.

Age is 55. Good.

Continuous enrollment good.

So final JSON:
{
  "status": "compliant",
  "reason": "Outpatient BP 132/84 on 2026-09-22 was below threshold."
}

Wait, the BP reading on 2026-05-06 was 142/88 (systolic not below 140). The reading on 2026-09-22 is the most recent outpatient reading (since 11/30 ED is skipped). It meets both <140 and <90. So numerator met.

Thus compliant.

Double-check no other nuance: "A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading." So the 11/30 ED reading is skipped. The most recent outpatient reading is indeed 9/22.

All set.

The required keys are "status" and "reason". No extra keys needed because it's not QM-FUM.

Let's ensure JSON is well-formed, no trailing commas, plain numbers if any. No dollar amounts. Dates are ISO. Good.

Reason must be under 30 words. "Outpatient BP 132/84 on 2026-09-22 was below threshold." is fine.

I'll produce exactly the JSON block.

We are given a quality measure QM-CBP, and we need to evaluate member 40114.

Measure: Blood pressure control in hypertension.

Denominator criteria:
- Age 18-85 as of 2026-12-31. DOB: 1971-09-03. As of 2026-12-31, age = 2026 - 1971 = 55. (If birthday is 9/3, by 12/31 she is 55). So age eligible.
- Event: at least one outpatient encounter with hypertension diagnosis (I10) between 2026-01-01 and 2026-06-30. She has I10 on 2026-02-11 and 2026-05-06, both in that window. So event present.
- Continuous enrolment: full year, no gaps. So eligible.

Exclusions:
- E1: ESRD or dialysis (N18.6, Z99.2) any time on or before 2026-12-31. None.
- E2: Pregnancy (O00-O9A) during measurement year. None.
- E3: Hospice or palliative care. None.
- E4: Died. Alive.

So no exclusions. Member remains in denominator.

Numerator: Most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter (which is the first I10? It says "on or after the date of the qualifying hypertension encounter". The qualifying encounter is the one that made her eligible; it's the first I10 encounter? The spec says: "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30." So the qualifying encounter is any such encounter. The numerator says: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic." So we need to identify the qualifying hypertension encounter date. Which one? The measure says "the qualifying hypertension encounter" - it likely means the earliest one that qualifies? Or any? Typically, the denominator event is the first qualifying encounter in the measurement period. But the spec doesn't specify "first". It says "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30." So the member has multiple such encounters. The numerator then says "on or after the date of the qualifying hypertension encounter". If there are multiple qualifying encounters, which one is used? Usually, the measure identifies the earliest qualifying encounter as the "index event" or "index date". The spec says "the qualifying hypertension encounter" - singular, implying the one that established the denominator. I think the standard interpretation is that the qualifying encounter is the earliest one that meets the criteria. So we'll take the first I10 encounter in the window: 2026-02-11.

Now, we need BP readings that are outpatient, on or after 2026-02-11, and before 2026-12-31. We must skip ED and inpatient readings. The most recent qualifying outpatient reading. The readings:

- 2026-02-11: Office visit, BP 148/92. This is the qualifying encounter date itself, but it's on that date. Is it on or after? It's on the date, so it qualifies. But it's a reading with systolic 148, diastolic 92, not below 140/90.
- 2026-05-06: Office visit, BP 142/88. Systolic 142, diastolic 88. Systolic is above 139, so not below 140.
- 2026-09-22: Office visit, BP 132/84. Both below 140/90. So this qualifies.
- 2026-11-30: ED visit, BP 156/96. This is an emergency department visit, so it is excluded ("A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading."). So we skip this.

The most recent qualifying outpatient BP reading is the 2026-09-22 reading: 132/84. That is below 140 systolic and below 90 diastolic. So numerator is met.

Thus, status = "compliant". Reason: "Most recent outpatient BP on 2026-09-22 was 132/84, below 140/90."

No QM-FUM keys needed. So final JSON: {"status": "compliant", "reason": "Most recent outpatient BP on 2026-09-22 was 132/84, below 140/90."}

Let me work through this step-by-step using the QM-CBP measure specification.

**Step 1: Check Eligibility for Denominator (not_eligible vs. in denominator)**

Age requirement: 18 through 85 years as of 2026-12-31
- Member DOB: 1971-09-03
- Age on 2026-12-31: 2026 - 1971 = 55 years old (will be 55 on 2026-09-03, already 55 by 2026-12-31)
- ✓ MEETS AGE REQUIREMENT

Event requirement: at least one outpatient encounter with hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30
- 2026-02-11: Office visit, diagnosis I10 ✓ (this is between 2026-01-01 and 2026-06-30)
- 2026-05-06: Office visit, diagnosis I10 ✓ (this is between 2026-01-01 and 2026-06-30)
- 2026-09-22: Office visit, diagnosis I10 (this is after 2026-06-30, does not count for establishing the event)
- ✓ MEETS EVENT REQUIREMENT (qualifying encounter is 2026-02-11 or 2026-05-06; the first one is 2026-02-11)

Continuous enrollment: enrolled for the full measurement year with no more than one gap of up to 45 days
- Enrollment: 2026-01-01 through 2026-12-31, continuous, no gaps
- ✓ MEETS ENROLLMENT REQUIREMENT
- Member qualifies for the denominator.

**Step 2: Check Required Exclusions**

Checking the note "No hospice, no pregnancy, no dialysis" against ESRD/dialysis (E1), pregnancy (E2), and hospice/palliative care (E3) - all three are explicitly ruled out.

E4. Died during the

measurement year - the record confirms the member was alive at year end, so E4 doesn't apply either.

No exclusions apply.

**Step 3: Evaluate Numerator**

Scanning encounters between 2026-01-01 and 2026-06-30 for the qualifying hypertension diagnosis, I10 appears on 2026-02-11 and again on 2026-05-06 - the first occurrence, 2026-02-11, sets the qualifying encounter date.

Now I need the most recent outpatient BP reading on or after 2026-02-11, excluding ED/inpatient values. The 2026-02-11 visit itself shows 148/92, and there's a later reading on 2026-05-06 to check as well.

Continuing through the readings: 2026-05-06 shows 142/88, 2026-09-22 shows 132/84, and 2026-11-30 is an ED visit (156/96) that must be excluded.

The most recent qualifying outpatient reading is 2026-09-22 at 132/84 - systolic 132 < 140 and diastolic 84 < 90, both under threshold. Member is compliant.

Reason: "Most recent outpatient BP reading 2026-09-22 was 132/84, below 140/90 threshold." - checking length, that's 11 words, well within the 30-word limit.

Now I need to verify which qualifying encounter establishes the "on or after" window - the member has two I10 encounters (2026-02-11 and 2026-05-06) within the qualifying period, and I should use the earliest one to give the longest window for BP control assessment.

This matches standard convention in quality measures, where "the qualifying encounter" typically refers to the first one meeting denominator criteria. So the earliest encounter date (2026-02-11) sets the start of the window for numerator BP readings.

Filtering readings after 2026-02-11, excluding ED/inpatient: 2026-05-06 (142/88), 2026-09-22 (132/84) qualify; the 2026-11-30 ED reading is excluded. Taking the most recent valid reading, 2026-09-22 shows 132/84, meeting both thresholds (<140 systolic, <90 diastolic) — compliant.

I should double-check whether "qualifying encounter" might instead require the BP reading to occur at that same visit, rather than any later visit.

e count: Most(1) recent(2) outpatient(3) BP(4) 132/84(5) on(6) 2026-09-22(7) below(8) 140/90(9) — 9 words, fits.

One more sanity check: does "on or after the date of the qualifying hypertension encounter" mean I filter readings to that window then pick the most recent? Yes — the qualifying encounter is 2026-02-11, so eligible readings are 148/92 (same day), 142/88 (05-06), 132/84 (09-22), and the 11-30 ED reading which gets excluded since it's not outpatient. That confirms 132/84 as the most recent qualifying outpatient reading.

Rechecking exclusions against the record ("No hospice, no pregnancy, no dialysis," "Member alive at year end"): no ESRD/dialysis, no pregnancy, no hospice/palliative care, and member didn't die — all clear, no exclusions apply.

Confirming eligibility: qualifying encounter 2026-02-11 falls within 2026-01-01–2026-06-30, and enrollment is continuous all year with no gaps.

So the member is compliant — most recent outpatient BP of 132/84 on 2026-09-22 is below 140/90.

Let me work through this quality measure logic step by step.

MEASURE: QM-CBP — BLOOD PRESSURE CONTROL IN HYPERTENSION
Measurement year: 2026-01-01 through 2026-12-31

STEP 1: Check if member is in the eligible population (denominator)

**Age requirement:** Age 18-85 as of 2026-12-31
- DOB: 1971-09-03
- Age as of 2026-12-31: 2026 - 1971 = 55 years old
- ✓ Eligible (18-85)

**Event requirement:** At least one outpatient encounter with hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30
- 2026-02-11: Office visit, diagnosis I10 ✓ (within the window)
- 2026-05-06: Office visit, diagnosis I10 ✓ (within the window)
- 2026-09-22: Office visit, diagnosis I10 (outside the window, after 2026-06-30)
- ✓ Eligible (has qualifying encounter on 2026-02-11)

**Continuous enrolment requirement:** Enrolled for full measurement year with no more than one gap of up to 45 days
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps
- ✓ Eligible

So the member IS in the eligible population/denominator.

STEP 2: Check exclusions (E1-E4)

E1. End stage renal disease (N18.6) or dependence on renal dialysis (Z99.2) any time on or before 2026-12-31
- Record says "No... dialysis"
- ✓ Not excluded

E2. Pregnancy (any O00-O9A code) during the measurement year — record says "no pregnancy" — ✓ Not excluded

E3. Hospice or palliative care during the measurement year — record says "No hospice" — ✓ Not excluded

E4. Died during the measurement year — record says "Member alive at year end" — ✓ Not excluded

No exclusions apply, so the member remains in the denominator.

STEP 3: Check numerator

The numerator requires the most recent outpatient BP reading, taken on or after the qualifying hypertension encounter and on or before 2026-12-31, to show systolic under 140 and diastolic under 90. Now I need to identify that reading.

The qualifying hypertension encounter must fall between 2026-01-01 and 2026-06-30. The earliest match is 2026-02-11.

Looking at outpatient BP readings on or after 2026-02-11:
- 2026-02-11: 148/92
- 2026-05-06: 142/88
- 2026-09-22: 132/84

The 2026-11-30 ED visit (156/96) doesn't count since it's not outpatient.

The most recent qualifying reading is 2026-09-22 at 132/84 — both systolic (<140) and diastolic (<90) are under threshold, so this member meets the numerator.

Status: compliant — in denominator, not excluded, numerator met via the 132/84 reading on 2026-09-22.

Reason: "Most recent outpatient BP (2026-09-22) of 132/84 is below 140/90 threshold."

Checking the qualifying event definition: an outpatient encounter with I10 diagnosis between 2026-01-01 and 2026-06-30 establishes eligibility. The member has two such encounters, on 2026-02-11 and 2026-05-06, so the hypertension event criterion is satisfied.

For the numerator, I need to find the most recent BP reading on or after the qualifying encounter date and on or before 2026-12-31. Using the earliest qualifying encounter (2026-02-11) as the start point, I'll scan for eligible outpatient readings from that date through year-end, starting with 148/92 recorded at the same 2026-02-11 visit.

Continuing through the eligible readings:
- 2026-05-06: 142/88 (office)
- 2026-09-22: 132/84 (office)
- 2026-11-30: 156/96 (ED - excluded)

The most recent valid reading is 2026-09-22 at 132/84. Checking against threshold: 132 < 140 systolic and 84 < 90 diastolic — both pass, so this member is compliant.

Double-checking the numerator language to confirm inpatient/ED readings don't count and both values must be below threshold simultaneously.

or inpatient, so it counts as the qualifying reading.

132 < 140 and 84 < 90 — both criteria met, so the numerator is satisfied.

Double-checking exclusions: no ESRD/dialysis, no pregnancy, no hospice/palliative care, member alive at year end — none apply.

```json
{
  "status": "compliant",
  "reason": "Most recent outpatient BP reading (2026-09-22, 132/84) is below 140/90 threshold."
}
```

That's well under the 30-word limit, so the reason is fine as written.

Double-checking dates: measurement year spans 2026-01-01 to 2026-12-31, and the qualifying encounter window is 2026-01-01 through 2026-06-30. The 2026-02-11 and 2026-05-06 encounters both fall within that window, but 2026-09-22 falls outside it since it's after 2026-06-30.

For the numerator, I need the most recent outpatient BP on or after the qualifying encounter date, excluding ED/inpatient readings. Scanning through: 2026-02-11 office (148/92), 2026-05-06 office (142/88), 2026-09-22 office (132/84), 2026-11-30 ED (excluded). The most recent qualifying reading is 132/84 from 2026-09-22 — both values fall under threshold, so this member is compliant.

Let me work through this member against the QM-CBP measure specification systematically.

**MEMBER DETAILS:**
- DOB: 1971-09-03
- Female
- Measurement year: 2026-01-01 through 2026-12-31
- Current date: 2026-09-02

**STEP 1: DENOMINATOR ELIGIBILITY**

Age requirement:
- As of 2026-12-31, member is age: 2026 - 1971 = 55 years old (will turn 55 on 2026-09-03)
- Actually, let me recalculate. Born 1971-09-03. On 2026-12-31, how old?
- From 1971-09-03 to 2026-09-03 = 55 years
- From 2026-09-03 to 2026-12-31 = additional months
- So on 2026-12-31, member is 55 years old
- Age range is 18-85. ✓ Member meets age requirement

Event requirement:
- Requires at least one outpatient encounter with hypertension diagnosis (I10) between 2026-01-01 and 2026-06-30
- 2026-02-11: Office visit with I10 diagnosis ✓
- This is an outpatient encounter in the qualifying period
- Member meets the event requirement

Continuous enrolment:
- Enrolled 2026-01-01 through 2026-12-31, continuous, no gaps
- Requirement: enrolled for full measurement year with no more than one gap of up to 45 days
- Member has no gaps
- Member meets enrolment requirement ✓

**DENOMINATOR STATUS: MEMBER IS IN THE DENOMINATOR**
**STEP 2: EVALUATE EXCLUSIONS**

Checking renal exclusion - no N18.6 or Z99.2 codes, record explicitly states no dialysis. Not excluded.

Checking pregnancy - none noted, record confirms no pregnancy. Not excluded.

Checking hospice/palliative care - record states no hospice. Not excluded.

Now checking whether the member died during the measurement year:

Record confirms "Member alive at year end." Not excluded.

**NO EXCLUSIONS APPLY**

**STEP 3: EVALUATE NUMERATOR**

Need the most recent outpatient BP reading, dated on/after the qualifying encounter (2026-02-11) and on/before 2026-12-31, with systolic <140 and diastolic <90. ED/inpatient readings don't count.

Scanning readings chronologically:
- 2026-02-11: outpatient, BP 148/92 — this is the qualifying encounter itself
- 2026-05-06: outpatient, BP 142/88 — still doesn't meet threshold (systolic ≥140)

30 words max - my draft fits fine. I'll settle on: "Most recent outpatient BP (2026-09-22): 132/84, below the 140/90 threshold." Concise, cites the deciding date and values.