diff --git a/cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/visitor/r4/ReleaseVisitor.java b/cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/visitor/r4/ReleaseVisitor.java
index 0957c5af59..1036a8f1cf 100644
--- a/cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/visitor/r4/ReleaseVisitor.java
+++ b/cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/visitor/r4/ReleaseVisitor.java
@@ -15,6 +15,7 @@
 import org.hl7.fhir.r4.model.Basic;
 import org.hl7.fhir.r4.model.Bundle;
 import org.hl7.fhir.r4.model.Bundle.BundleEntryComponent;
+import org.hl7.fhir.r4.model.CanonicalType;
 import org.hl7.fhir.r4.model.Extension;
 import org.hl7.fhir.r4.model.Library;
 import org.hl7.fhir.r4.model.Measure;
@@ -163,11 +164,17 @@ public static List<BundleEntryComponent> findArtifactCommentsToUpdate(
 
     public static void extractDirectReferenceCodes(IKnowledgeArtifactAdapter rootAdapter, Measure measure) {
         Optional<Extension> effectiveDataRequirementsExt = measure.getExtension().stream()
-                .filter(ext -> ext.getUrl().equals(Constants.CQFM_EFFECTIVE_DATA_REQUIREMENTS))
+                .filter(ext -> ext.getUrl().equals(Constants.CQFM_EFFECTIVE_DATA_REQUIREMENTS)
+                        || ext.getUrl().equals(Constants.CRMI_EFFECTIVE_DATA_REQUIREMENTS))
                 .findFirst();
         if (effectiveDataRequirementsExt.isPresent()) {
-            Reference ref = (Reference) effectiveDataRequirementsExt.get().getValue();
-            Library effectiveDataRequirementsLib = (Library) measure.getContained("#" + ref.getReference());
+            Library effectiveDataRequirementsLib = null;
+            if (effectiveDataRequirementsExt.get().getValue() instanceof Reference ref) {
+                effectiveDataRequirementsLib = (Library) measure.getContained("#" + ref.getReference());
+            } else if (effectiveDataRequirementsExt.get().getValue() instanceof CanonicalType canonicalType) {
+                effectiveDataRequirementsLib = (Library) measure.getContained("#" + canonicalType.asStringValue());
+            }
+
             if (effectiveDataRequirementsLib != null) {
                 effectiveDataRequirementsLib.getExtension().stream()
                         .filter(ext -> ext.getUrl().equals(Constants.CQFM_DIRECT_REFERENCE_EXTENSION))
diff --git a/cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/visitor/r5/ReleaseVisitor.java b/cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/visitor/r5/ReleaseVisitor.java
index a906d08185..85ce5c1d23 100644
--- a/cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/visitor/r5/ReleaseVisitor.java
+++ b/cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/visitor/r5/ReleaseVisitor.java
@@ -15,6 +15,7 @@
 import org.hl7.fhir.r5.model.ArtifactAssessment;
 import org.hl7.fhir.r5.model.Bundle;
 import org.hl7.fhir.r5.model.Bundle.BundleEntryComponent;
+import org.hl7.fhir.r5.model.CanonicalType;
 import org.hl7.fhir.r5.model.Extension;
 import org.hl7.fhir.r5.model.Library;
 import org.hl7.fhir.r5.model.Measure;
@@ -150,11 +151,16 @@ public static List<BundleEntryComponent> findArtifactCommentsToUpdate(
 
     public static void extractDirectReferenceCodes(IKnowledgeArtifactAdapter rootAdapter, Measure measure) {
         Optional<Extension> effectiveDataRequirementsExt = measure.getExtension().stream()
-                .filter(ext -> ext.getUrl().equals(Constants.CQFM_EFFECTIVE_DATA_REQUIREMENTS))
+                .filter(ext -> ext.getUrl().equals(Constants.CQFM_EFFECTIVE_DATA_REQUIREMENTS)
+                        || ext.getUrl().equals(Constants.CRMI_EFFECTIVE_DATA_REQUIREMENTS))
                 .findFirst();
         if (effectiveDataRequirementsExt.isPresent()) {
-            Reference ref = effectiveDataRequirementsExt.get().getValueReference();
-            Library effectiveDataRequirementsLib = (Library) measure.getContained("#" + ref.getReference());
+            Library effectiveDataRequirementsLib = null;
+            if (effectiveDataRequirementsExt.get().getValue() instanceof Reference ref) {
+                effectiveDataRequirementsLib = (Library) measure.getContained("#" + ref.getReference());
+            } else if (effectiveDataRequirementsExt.get().getValue() instanceof CanonicalType canonicalType) {
+                effectiveDataRequirementsLib = (Library) measure.getContained("#" + canonicalType.getCanonical());
+            }
             if (effectiveDataRequirementsLib != null) {
                 effectiveDataRequirementsLib.getExtension().stream()
                         .filter(ext -> ext.getUrl().equals(Constants.CQF_DIRECT_REFERENCE_EXTENSION))
diff --git a/cqf-fhir-cr/src/test/java/org/opencds/cqf/fhir/cr/visitor/r4/ReleaseVisitorTests.java b/cqf-fhir-cr/src/test/java/org/opencds/cqf/fhir/cr/visitor/r4/ReleaseVisitorTests.java
index b234306b48..c63667ae11 100644
--- a/cqf-fhir-cr/src/test/java/org/opencds/cqf/fhir/cr/visitor/r4/ReleaseVisitorTests.java
+++ b/cqf-fhir-cr/src/test/java/org/opencds/cqf/fhir/cr/visitor/r4/ReleaseVisitorTests.java
@@ -263,10 +263,6 @@ void measureDirectReferenceCodesIncludedInReleaseTest() {
         Parameters params = new Parameters();
         params.addParameter("version", "1.0.0");
         params.addParameter("versionBehavior", new CodeType("default"));
-        var crmiEDRId = "exp-params-crmi-test";
-        var crmiEDRExtension = new Extension();
-        crmiEDRExtension.setUrl(Constants.CRMI_EFFECTIVE_DATA_REQUIREMENTS);
-        crmiEDRExtension.setValue(new CanonicalType("#" + crmiEDRId));
         ReleaseVisitor releaseVisitor = new ReleaseVisitor(repo);
         // Approval date is required to release an artifact
         library.setApprovalDateElement(new DateType("2024-04-23"));
diff --git a/cqf-fhir-cr/src/test/java/org/opencds/cqf/fhir/cr/visitor/r5/ReleaseVisitorTests.java b/cqf-fhir-cr/src/test/java/org/opencds/cqf/fhir/cr/visitor/r5/ReleaseVisitorTests.java
index e874aacdd1..dc7f8863d1 100644
--- a/cqf-fhir-cr/src/test/java/org/opencds/cqf/fhir/cr/visitor/r5/ReleaseVisitorTests.java
+++ b/cqf-fhir-cr/src/test/java/org/opencds/cqf/fhir/cr/visitor/r5/ReleaseVisitorTests.java
@@ -264,10 +264,6 @@ void measureDirectReferenceCodesIncludedInReleaseTest() {
         Parameters params = new Parameters();
         params.addParameter("version", "1.0.0");
         params.addParameter("versionBehavior", new CodeType("default"));
-        var crmiEDRId = "exp-params-crmi-test";
-        var crmiEDRExtension = new Extension();
-        crmiEDRExtension.setUrl(Constants.CRMI_EFFECTIVE_DATA_REQUIREMENTS);
-        crmiEDRExtension.setValue(new CanonicalType("#" + crmiEDRId));
         ReleaseVisitor releaseVisitor = new ReleaseVisitor(repo);
         // Approval date is required to release an artifact
         library.setApprovalDateElement(new DateType("2024-04-23"));
diff --git a/cqf-fhir-cr/src/test/resources/org/opencds/cqf/fhir/cr/visitor/r4/Bundle-ecqm-qicore-2024-simplified.json b/cqf-fhir-cr/src/test/resources/org/opencds/cqf/fhir/cr/visitor/r4/Bundle-ecqm-qicore-2024-simplified.json
index 6d2598a141..80222be323 100644
--- a/cqf-fhir-cr/src/test/resources/org/opencds/cqf/fhir/cr/visitor/r4/Bundle-ecqm-qicore-2024-simplified.json
+++ b/cqf-fhir-cr/src/test/resources/org/opencds/cqf/fhir/cr/visitor/r4/Bundle-ecqm-qicore-2024-simplified.json
@@ -3841,10 +3841,8 @@
         "extension": [
           {
             "id": "effective-data-requirements",
-            "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
-            "valueReference": {
-              "reference": "#effective-data-requirements"
-            }
+            "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
+            "valueCanonical": "#effective-data-requirements"
           },
           {
             "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem",
diff --git a/cqf-fhir-cr/src/test/resources/org/opencds/cqf/fhir/cr/visitor/r5/Bundle-ecqm-qicore-2024-simplified.json b/cqf-fhir-cr/src/test/resources/org/opencds/cqf/fhir/cr/visitor/r5/Bundle-ecqm-qicore-2024-simplified.json
index 72e9db70dc..41a9e562cf 100644
--- a/cqf-fhir-cr/src/test/resources/org/opencds/cqf/fhir/cr/visitor/r5/Bundle-ecqm-qicore-2024-simplified.json
+++ b/cqf-fhir-cr/src/test/resources/org/opencds/cqf/fhir/cr/visitor/r5/Bundle-ecqm-qicore-2024-simplified.json
@@ -3841,10 +3841,8 @@
         "extension": [
           {
             "id": "effective-data-requirements",
-            "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
-            "valueReference": {
-              "reference": "#effective-data-requirements"
-            }
+            "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
+            "valueCanonical": "#effective-data-requirements"
           },
           {
             "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem",