NCQA or its licensors own all rights, title and interests in the Product, including trade secrets, patents, copyrights and database rights, and the Product shall remain the sole and exclusive property of NCQA (except as otherwise set forth below regarding third party copyright ownership of portions of HEDIS VSDs). Licensee Representation and WarrantyLicensee represents and warrants to NCQA that this License Agreement shall be binding on Licensee, and, unless Licensee is an individual, Licensee represents and warrants that this License Agreement was executed by an authorized signatory of Licensee with the authority to enter into binding agreements on behalf of Licensee. Licensee means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the License Agreement terms below. XVII. All other uses, including a commercial use (including but not limited to vendors or consultants using or embedding the measures and specifications and/or Value Set Directory into any product or service to calculate measure results or provide any measure-related service to customers for any purpose) and/or any internal or external reproduction, distribution or publication (including but not limited to federal and state entities using or incorporating the measures into their programs) must be approved by NCQA and are subject to a license at the discretion of NCQA. All notices to be given under this License Agreement to Licensee shall be submitted by NCQA via e-mail at the account Licensee provided to NCQA. %PDF-1.5
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HEDIS Measures relate to many significant public health issues, such as cancer, heart disease, smoking, asthma, and diabetes. I. ProductThis version and any updates to this version provided by NCQA, whether in hard copy or electronic publication, and any related documentation, including, but not limited to, the user's manual, unless provided under the terms of a separate license agreement (collectively, the "Product"). NCQA Accreditation: MCOs are required to be accredited, which necessitates continuous analysis of opportunities to improve coordination of care. 3.0 : May 2019 Share this page with a friend or colleague by Email.
NCQA established Healthcare Effectiveness Data and Information Set (HEDIS) measures specifically for SNPs. 1. As applicable, the Product is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. h\AN@E27dRTQbQB*=vX{r$e K8Z+*;e_?St*[|e[o-;/6MpnC\Hdy rL|LIr2e_D,F1+^1W+s N$oK)R493{py #xtV>zxk13No9:C_ eH__C/WpGOav4 `mdm:"d5mauw4a]`}+\#6'M
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s.M0bY4BIub0h2`Lot Except for authorized Licensed Users, each person, entity, organization or association, including agents and consultants of the Licensee, is required to separately purchase a license to obtain and access the Product. XIV. TerminationNCQA may terminate this License Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. III. Noncompliance may also disqualify Licensee from receiving future goods and services from NCQA.To verify compliance with this License Agreement, NCQA is granted the right, with prior notice and during normal business hours, to examine all relevant records of Licensee. <>
Eligibility requirements, application information and policies and procedures are included as well. NCQA holds a copyright in the measures and specifications and may rescind or alter these measures and specifications at any time. 1 0 obj
NCQA or its licensors own all rights, title and interests in the Product, including trade secrets, patents, copyrights and database rights, and the Product shall remain the sole and exclusive property of NCQA (except as otherwise set forth below regarding third party copyright ownership of portions of HEDIS VSDs). hb```e``@(\>3,`a\Tf CAAPV$wCMm]uc9MSYtr;lI^@fnlna?NUIJj2@{y8B \]$g/Qe SrO$[@,g^P^^D;L@9#P`
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NCQA Utilization Management Accreditation is designed to ensure that organizations can consistently make appropriate and timely decisions. HEDIS VSDs are made separately available, at no cost, in electronic format. 2008 NCQA launched the first PCMH Recognition program, 2011/ 2014 NCQA raised the bar with updates to PCMH Recognition. BECAUSE SOME STATES OR JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY FOR DAMAGES (SUCH AS CONSEQUENTIAL OR INCIDENTAL DAMAGES), OR THE EXCLUSION OF IMPLIED WARRANTIES AND LIMITATIONS ON HOW LONG AN IMPLIED WARRANTY MAY LAST, THE ABOVE LIMITATIONS MAY NOT APPLY TO LICENSEE, TO THE EXTENT THAT LIABILITY IS, BY LAW, INCAPABLE OF EXCLUSION OR RESTRICTION. No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. Licensee Representation and WarrantyLicensee represents and warrants to NCQA that this License Agreement shall be binding on Licensee, and, unless Licensee is an individual, Licensee represents and warrants that this License Agreement was executed by an authorized signatory of Licensee with the authority to enter into binding agreements on behalf of Licensee. 2'sYP'IeIFH5-st#,Z5v&*}"xC0!"#:#}?rjJS',#l2u)h3p+a:fRlA8E@9~fBa"=KQY(?\mq1)gg$\y#cvnG54h0'[#0YNdR8}2e. We do not share your information with third parties. Specifications for the Medicare Health Outcomes Survey, Case Management (CM) and Long-Term Services and Supports (LTSS), Managed Behavioral Healthcare Organizations (MBHO), Utilization Management/Credentialing/Provider Network (UM/CR/PN), Credentials Verification Organizations (CVO), Patient-Centered Specialty Practice (PCSP), California Align Measure Perform (AMP) & Value Based Pay for Performance (VBP4P), Skip to the beginning of the images gallery. Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store. -LTSS Accreditation policies and procedures under 5: Additional Information.) 133 0 obj
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NCQA sets standards for interpreting NCQA Accreditation standards and HEDIS measures. THE LIMITATIONS OF DAMAGES AND LIABILITIES SET FORTH IN THIS LICENSE AGREEMENT ARE FUNDAMENTAL ELEMENTS OF THE BASIS OF THE BARGAIN BETWEEN NCQA AND LICENSEE, AND THE PRICING FOR THE LICENSE REFLECTS SUCH LIMITATIONS. Either of the above methods will give you immediate access to the standards. hb```f``*e`e` ",l@qA $2>Qs*C>2bf.6AB^;x1K_YlQlqc]>'@2'oSQ"|*x TdB^9WACh0F HEDIS VSDs contain code values owned by third parties (the Third Party Code Values), including CPT owned by American Medical Association, LOINC owned by Regenstrief Institute, Inc., SNOMED CT owned by the International Health Terminology Standards Development Organisation, and Uniform Billing Codes owned by the American Hospital Association. 4 0 obj
NCQAs failure to exercise or enforce any right or power under this License Agreement shall not constitute a waiver of such right or power. Licensee means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the License Agreement terms below. An organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. THIS LIMITED WARRANTY GIVES YOU SPECIFIC LEGAL RIGHTS, AND YOU MAY ALSO HAVE OTHER RIGHTS THAT VARY FROM JURISDICTION TO JURISDICTION. Remedies and AuditAny breach of this License Agreement of any terms herein by Licensee may cause irreparable harm to NCQA for which no adequate remedy at law exists and may subject Licensee to injunctive relief and all legal and equitable remedies available to NCQA, including, but not limited to, recovery of all costs and expenses, including reasonable attorney's fees incurred because of any such legal action. This License Agreement may not be modified by Licensee except upon mutual agreement by the parties in writing, signed by an authorized representative of NCQA. 2017 NCQA further advanced its PCMH program through Recognition Redesign. NCQA Utilization Management Accreditation is for organizations that provide full-scope utilization management services. Eligibility requirements, application information and policies and procedures are also included. An explanation of the 8 and 30 file sampling procedure used by NCQA during accreditation survey visits. y(ALshU~ NmuE)T"Z5]qhhiP3f[T+zSE'1I-Zg}T8kcm0GKS-vcEZ)/^d_S!CQK|]Q8mAaZ3x0Q*8I!9fXf=?OL8S-}ZTf2){C[${" ]n uA^3)_=Ygu/!~O{>w;^ w5q
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K~#s XVI. 2019 Clinical Quality Measure Flow Narrative for Quality ID #50: Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older Please refer to the specific section of the specification to identify the denominator and numerator information for use in submitting this Individual Specification. <>/Metadata 330 0 R/ViewerPreferences 331 0 R>>
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. National Health Care for the Homeless Council - Quality. XIV. All notices to be given under this License Agreement to NCQA shall be submitted to NCQA at 1100 13th Street NW, Washington, D.C. 20005, Attention: Licensee Support. 1 0 obj
NCQA's PCMH program is the largest, with more than 65,000 cliniciansabout 18 percent of all primary care cliniciansat 14,000 sites as of June 2018. hbbd```b``~"R Added additional examples of logic in each section to provide context : 3.0 . endobj
Copyright 2023 National Committee for Quality Assurance. 3.0 : May 2019 . y+,^ y{Ay|kd Y|E1/!s|_+Le{l|1gc0Ow. Requirements cover these key areas: To see all program requirements, get the Standards and Guidelines document. ModificationsThis License Agreement is the complete and exclusive statement of the agreement between Licensee and NCQA, and supersedes any proposal or prior agreement, oral or written, and any other communications between the parties relating to the subject matter of this License Agreement. THIS LIMITED WARRANTY GIVES YOU SPECIFIC LEGAL RIGHTS, AND YOU MAY ALSO HAVE OTHER RIGHTS THAT VARY FROM JURISDICTION TO JURISDICTION. Licensee acknowledges that the Product remains the full and exclusive property of NCQA. Copyright Notice RequiredThe Product contains proprietary and copyrighted information and notice to that effect must appear on all authorized copies of the Product made by Licensee under this License Agreement. Prohibited Use AcknowledgmentAn organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. NCQA will release the 2021 Health Plan Ratings (HPR) for all product lines in September 2021. Licensee agrees to maintain the Product in strict confidence and abide by all terms and conditions of this License Agreement. I. ProductThis version and any updates to this version provided by NCQA, whether in hard copy or electronic publication, and any related documentation, including, but not limited to, the user's manual, unless provided under the terms of a separate license agreement (collectively, the "Product"). 4 0 obj
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SNPs can use HEDIS performance data to identify opportunities for improvement, monitor the success of quality improvement initiatives, track improvement, and provide a set of measurement standards that allow comparison with other plans. A review of the commonly accepted standards for medical record documentation. To ACCEPT this License Agreement, click the accompanying checkbox/button to accept the terms of this product, which will create a legal contract that will bind Licensee and NCQA. Share sensitive information only on official, secure websites. All notices to be given under this License Agreement to NCQA shall be submitted to NCQA at 1100 13th Street NW, Washington, D.C. 20005, Attention: Licensee Support. In the event NCQA receives notification within the warranty period of any defects in the media, NCQA will, at its option, either replace such defective media or return to Licensee the price paid for the Product. Share this page with a friend or colleague by Email. 0
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And more than 100 payers support NCQA recognition through financial incentives or coaching. NCQA DISCLAIMS AND MAKES NO WARRANTY OR REPRESENTATIONS AS TO THE ACCURACY, QUALITY, RELIABILITY, SUITABILITY, COMPLETENESS, TRUTHFULNESS, USEFULNESS, OR EFFECTIVENESS OF DATA CONTAINED IN ANY PRODUCT. The License is not transferable from Licensee to any other person, entity, organization or association. THE LIMITATIONS OF DAMAGES AND LIABILITIES SET FORTH IN THIS LICENSE AGREEMENT ARE FUNDAMENTAL ELEMENTS OF THE BASIS OF THE BARGAIN BETWEEN NCQA AND LICENSEE, AND THE PRICING FOR THE LICENSE REFLECTS SUCH LIMITATIONS. VI. tc;m1aIb Read this License Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. IX. NCQA Utilization Management Accreditation is designed to ensure that organizations can consistently make appropriate and timely decisions. Hard copies of 2020 Health Plan Accreditation Standards and Guidelines available for purchase. The License is not transferable from Licensee to any other person, entity, organization or association. ( The Product is protected by applicable United States and foreign laws and treaties, including copyright laws and treaty provisions. View Table of Contents for this Publication. 2 0 obj
Licensee acknowledges and agrees that it is responsible for obtaining a license directly from the copyright owner of each of the Third-Party Code Values, if required. For Value Set Directory (VSD) Downloads. XI. II. This License Agreement will not be governed by the United Nations Convention on Contracts for the International Sale of Goods, the application of which is expressly excluded. 3 0 obj
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The individual accepting this License Agreement on behalf of Licensee represents that by electronically signing this License Agreement, the individual hereby binds the Licensee to the terms of this License Agreement, and that such individual is an employee of Licensee and duly authorized to enter into and bind Licensee to the terms of this License Agreement. If the military hospital or clinic can't get you an appointment with your primary care manager within the access standards (within 24 hours - 1 day), they will get you an appointment with another provider. Requiring all Covered California QHPs achieve NCQA accreditation will be minimally disruptive as NCQA ("NCQA"). XH> {
,lyDJ^ IjL`2LLX Changes to NCQA Accreditation and Certification Standards for 2018 and 2019 (June 26, 2018) Modifying NCQA Requirements in Response to Hurricanes and other Natural Disasters (September 7, 2017) Utilization Management: Changes to UM 4, Appropriate Classification of Denials; the Future of Utilization Management (July 31, 2017) endstream
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Using appropriate professionals. Users of these Products will be required to accept a separate Usage Agreement in NCQAs Download Center before accessing the Products. Y)d&BZ$C#t0iT_Dy/D: `byhB7;)*RD )EEB "{*(Ah=AMYh& ZY@T.YKVu. 2019 Clinical Quality Measure Flow Narrative for Quality ID #236 NQF #0018: Controlling High Blood Pressure Read this License Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. IN NO EVENT WILL NCQA'S TOTAL LIABILITY FOR ANY DIRECT DAMAGES RESULTING FROM ANY CLAIMS, DEMANDS OR ACTIONS ARISING OUT OF OR RELATING TO THE PRODUCT OR ANY PART THEREOF, OR THIS LICENSE AGREEMENT, EXCEED THE PRICE PAID FOR THE PRODUCT, WHETHER SUCH LIABILITY ARISES FROM ANY CLAIM BASED ON CONTRACT, WARRANTY, TORT OR OTHERWISE. @Xn^xJps You can decide how often to receive updates. hV[o;+~l^[CE"6*`o]B&VfyT &b:@5fQ%D3f
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U9Ldd|V.hsGBt,Bu T#l+ Dv.E Zv?bkvir{~Y&m:S Anyone contemplating a use beyond a personal, non-commercial use, including but not limited to a commercial use, internal or external reproduction, distribution or publication of any part of a Product or use of a Product to identify records or calculate HEDIS measure results, must contact the NCQA licensing team by submitting a request through https://my.ncqa.org to discuss the need for a license.Licensee agrees and understands that any score or numeric result calculated from access and use of the Product does not constitute a preliminary or final score and does not predict achievement of accreditation, certification or recognition, as applicable. X. SeverabilityIf any portion of this License Agreement is determined by a court of competent jurisdiction or any appropriate legislature to be wholly or partially unenforceable, for any reason, such unenforceability shall not affect the balance hereof. x
#-;g'bI&Z$@DD*.-;7Wu:orWm\|~uQmx! For the best experience on our site, be sure to turn on Javascript in your browser. NOTE: This License Agreement is null and void as related to the following NCQA Products (as such term is defined in Section I below): Risk Adjustment Tables, HEDIS Medication List Directory and CA DHCS QIP (any) Edition of HEDIS Digital Measures Bundle For ECDS Reporting. The 2020 Health Plan Accreditation Standards and Guidelines were released on July 29, 2019. NCQA Corrections, Clarifications and Policy Changes to the 2021 HPA Standards and Guidelines July 26, 2021 Key = COCorrection, CLClarification, PCPolicy Change 4 PREVIOUSLY POSTED UPDATES Page Standard/Element Head/Subhead Update Type of Update IRT Release Date NCQA schedules the survey for submission 6 months following the last full Users must still click the I AGREE checkbox at the end of this License Agreement to access those Products, but the terms of this License Agreement will have no legal effect. Copyright Notice RequiredThe Product contains proprietary and copyrighted information and notice to that effect must appear on all authorized copies of the Product made by Licensee under this License Agreement. A PDF reader is . ) NCQA accreditation standards include a Population Health Management domain, which is unique to NCQA and requires a systematic approach to develop a population health strategy, program, member and delivery systems supports, and impact evaluation. %
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A Licensed User may not be an agent or consultant of a Licensee. Except as provided for in Section II above, Licensee has no, and is not granted, any right, title, interest or other license in the Product. Contact and NoticesShould Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. This Publication License Agreement, along with all materials referenced herein ("License Agreement"), is a legal agreement between the individual or entity purchasing the license to use the Product (hereinafter the Licensee) and the National Committee for Quality Assurance (NCQA). The 2020 HP Survey Tool was released on March 30, 2020. 2020 Health Plan Survey Tool released (with standards included). "Y`>X ?H D $WZ vd7k +LF8#Dte`bd`\8^
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Unauthorized internal distribution of the Product and materials therein - beyond the number of Licensed Users by your organization - is prohibited. Appropriate client agreements and collaboration. 57awmjUkP%N^H/I[d 8h,jsqQ'PFp&gjFo 0oN/wOptE"oKx Uawh/.S >t
Users must still click the I AGREE checkbox at the end of this License Agreement to access those Products, but the terms of this License Agreement will have no legal effect. XII. ModificationsThis License Agreement is the complete and exclusive statement of the agreement between Licensee and NCQA, and supersedes any proposal or prior agreement, oral or written, and any other communications between the parties relating to the subject matter of this License Agreement. 2020 Core Set of Behavioral Health Measures for Medicaid and CHIP (Behavioral Health Core Set) To support CMS's efforts to improve behavioral health in Medicaid and CHIP, CMS identified a core set of 18 behavioral health measures for voluntary reporting by state Medicaid and CHIP agencies. Copyright 2023 National Committee for Quality Assurance. Ye96Zl%)b>eP|P%#vp\a8SnV6[we2|-VGU*Jx>nb~57u|,v%tySb?VFHnj[2O W*_ Eligible organizations: Note: Members refers to membership of clients and organizations. Submit a question to, Patient-Centered Specialty Practice (PCSP), Credentials Verification Organization (CVO), Managed Behavioral Healthcare Organization (MBHO), Health Information Technology Prevalidation Programs, Virtual Seminars, Webinars and On-demand Training, Advertising and Marketing Your NCQA Status, Policy: NCQA Accreditation and Certification, Changes to the 2020 WHP Standards and Measures, Changes to NCQA Accreditation Standards for 2019 and 2020 Standards Years, Changes to NCQA Accreditation and Certification Standards for 2018 and 2019, Modifying NCQA Requirements in Response to Hurricanes and other Natural Disasters, Utilization Management: Changes to UM 4, Appropriate Classification of Denials; the Future of Utilization Management, Changes to NCQA Accreditation and Certification Standards for 2016 and 2017. 120 0 obj
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We anticipate, in 2019, further state legislative action to ensure health plans meet requisite standards for hospital-based physician network adequacy. The evaluator will assess the practice's progress towards recognition and provide immediate personalized feedback. .gov NCQA typically releases the survey tool at the same time it releases the standards. stream
Governing Law and General ProvisionsThis License Agreement shall be governed and construed in accordance with the laws of the District of Columbia without regard to its choice of laws. License GrantNCQA hereby grants Licensee a personal, non-exclusive, non-transferable license to use the Product in accordance with the terms of this License Agreement. IV. XVII. The 2020 Health Plan Accreditation Standards and Guidelines were released on July 29, 2019. In the event NCQA receives notification within the warranty period of any defects in the media, NCQA will, at its option, either replace such defective media or return to Licensee the price paid for the Product. May 2019 : Added clarifying language to content in each section . An official website of the United States government Data allow identification of performance gaps and establishment of realistic targets for improvement. O0
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Sign up to get the latest information about your choice of CMS topics. HEDIS is a comprehensive set of standardized performance measures designed to provide purchasers and consumers with the information they need for reliable comparison of health plan performance. Licensee may need additional software to use the Product, and NCQA is not responsible for such additional software. XVI. HEDIS Measures relate to many significant . Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store. <>
Secure .gov websites use HTTPSA \bMQ!HQd2`/_$EFcGI'.mG_|qxcB3XLf. NCQA Element . Warranty and DisclaimerNCQA warrants that the media on which the Product is furnished will be free of defects in materials and workmanship under normal use for a period of ninety (90) days from the date of purchase. IV. Any use of the Product to identify records or calculate HEDIS measure results, for example, requires a custom license and may necessitate certification pursuant to NCQAs Measure Certification Program. Upon accessing the Product, the Licensee is deemed to have accepted the license subject to the terms and conditions of this License Agreement. Upon termination, Licensee agrees to immediately return to NCQA or destroy, at NCQAs option, all copies of the Product, together with any back-up copy, modifications and any merged portions, in any form, in Licensee's possession. NCQA makes updates or clarifications to Standards & Guidelines several times per year, as needed. 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