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A Licensed User may not be an agent or consultant of a Licensee. endstream endobj 289 0 obj <> endobj 290 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Type/Page>> endobj 291 0 obj <>stream Limitation of LiabilityIN NO EVENT WILL NCQA BE LIABLE FOR ANY CONSEQUENTIAL, PUNITIVE, SPECIAL, INCIDENTAL, EXEMPLARY, INDIRECT OR OTHER SIMILAR DAMAGES, INCLUDING, WITHOUT LIMITATION, LOSS OR INACCURACY OF DATA, LOSS OF BUSINESS OR LOSS OF PROFITS ARISING OUT OF THE USE OR INABILITY TO USE THE PRODUCT, EVEN IF NCQA HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, AND IN NO EVENT SHALL NCQA BE RESPONSIBLE FOR ANY CLAIMS OF THIRD PARTIES. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Healthcare Effectiveness Data and Information Set (HEDIS), Chronic Condition Special Needs Plans (C-SNPs), Dual Eligible Special Needs Plans (D-SNPs), Institutional Special Needs Plans (I-SNPs), Use of Spirometry Testing in the Assessment and Diagnosis of COPD, Pharmacotherapy Management of COPD Exacerbation, Persistence of Beta-Blocker Treatment After a Heart Attack, Annual Monitoring for Patients on Persistent Medications, Potentially Harmful Drug-Disease Interactions in the Elderly, Use of High-Risk Medications in the Elderly, Osteoporosis Management in Women Who Had a Fracture, Follow-Up After Hospitalization for Mental Illness. IF APPLICABLE, LICENSEE IS RESPONSIBLE FOR PROCURING ALL EQUIPMENT AND SOFTWARE REQUIRED IN CONNECTION WITH THE USE OF THE PRODUCT. XV. 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. ePub and web-based licenses for 2020 Health Plan Accreditation Standards and Guidelines available for purchase. tc;m1aIb endobj endstream endobj 1815 0 obj <>stream JavaScript seems to be disabled in your browser. RnI0O [.A lock If any part of this License Agreement is found void and unenforceable, it will not affect the validity of the remainder of the License Agreement, which shall remain valid and enforceable according to its terms. -LTSS Accreditation policies and procedures under 5: Additional Information.) endobj The timing is flexible and up to the practice to determine. All uses of these Third-Party Code Values may require a license from the copyright owner. stream This publication features in-depth explanations and examples of how to meet the standards, accreditation scoring guidelines and points, accreditation outcomes and reporting categories. 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. Requirements cover these key areas: Applying an internal QI process. 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 endobj 1817 0 obj <>stream HEDIS Measures relate to many significant . 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. V. OwnershipTitle to and full ownership of the Product belongs to NCQA. 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. NCQA Corrections, Clarifications and Policy Changes to the 2019 PHP Standards and Guidelines March 27, 2023 Key = COCorrection, CLClarification, PCPolicy Change 3 PREVIOUSLY POSTED UPDATES Page Standard/Element Head/Subhead Update Type of Update IRT Release Date personal residence or U.S. statutory agent unless the organization . %PDF-1.5 % Upon accessing the Product, the Licensee is deemed to have accepted the license subject to the terms and conditions of this License Agreement. Upon accessing the Product, the Licensee is deemed to have accepted the license subject to the terms and conditions of this License Agreement. License RestrictionsLicensee may not itself or permit others to: (i) Use the Product or any portion thereof for any purpose other than as specifically set forth in this License Agreement;(ii) Identify records or calculate HEDIS measure results using the Product;(iii) Distribute, sublicense or copy the Product in any format, including, but not limited to, other print or electronic publication service or product (except that Licensee may make one [1] copy for each Licensed User for which Licensee has purchased a license to use the Product);(iv) Decompile, disassemble the Product, analyze or otherwise examine the Product for the purpose of reverse engineering;(v) Delete or in any manner alter any notices, disclaimers or other legends contained in the Product or appearing on any screens, documents or other materials obtained through use of the Product;(vi) Provide service bureau facilities or commercial time-sharing services to any third party or supporting operations for any third party through access and/or use of the Product;(vii) Reproduce, republish, upload, post, transmit or distribute the Product, or any portion thereof, or facilitate or permit any third party to do so;(viii) Modify or prepare derivative works from the Product;(ix) Use any device or software to interfere or attempt to interfere with the proper operation of the Product;(x) Ship, transmit, transfer or export the Product into any country or use the Product in any manner prohibited by United States export laws, restrictions or regulations;(xi) Transmit the Product electronically or allow access to the Product over a network or a public computer-based information system which permits access to a greater number of users than licensed by Licensee;(xii) Use the Product in multiple computer or multiple user arrangements unless that use is covered by a separate license for each computer or user; or(xiii) Rent, lease, or distribute or otherwise transfer possession of any copy of the Product to any third party. An organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. Licensee agrees to indemnify and hold NCQA harmless from any claims and expenses arising out of Licensees use and display of Third-Party Code Values included in the HEDIS VSDs, or any portion thereof. %PDF-1.7 2008 NCQA launched the first PCMH Recognition program, 2011/ 2014 NCQA raised the bar with updates to PCMH Recognition. 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 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. TerminationNCQA may terminate this License Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. (+vKIr65bGAqd2NsRbb4p*Jhu({4:`2$tEHDn0_.K_^oe>/&M-v ,hBzG-edxldfjP cqzty0rfUo5RZwe(Q\LFWM4{:3P{CbSoL@AkV>7=|@-A-X-zYV0 1 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. We look forward to further dialogue . % License RestrictionsLicensee may not itself or permit others to: (i) Use the Product or any portion thereof for any purpose other than as specifically set forth in this License Agreement;(ii) Identify records or calculate HEDIS measure results using the Product;(iii) Distribute, sublicense or copy the Product in any format, including, but not limited to, other print or electronic publication service or product (except that Licensee may make one [1] copy for each Licensed User for which Licensee has purchased a license to use the Product);(iv) Decompile, disassemble the Product, analyze or otherwise examine the Product for the purpose of reverse engineering;(v) Delete or in any manner alter any notices, disclaimers or other legends contained in the Product or appearing on any screens, documents or other materials obtained through use of the Product;(vi) Provide service bureau facilities or commercial time-sharing services to any third party or supporting operations for any third party through access and/or use of the Product;(vii) Reproduce, republish, upload, post, transmit or distribute the Product, or any portion thereof, or facilitate or permit any third party to do so;(viii) Modify or prepare derivative works from the Product;(ix) Use any device or software to interfere or attempt to interfere with the proper operation of the Product;(x) Ship, transmit, transfer or export the Product into any country or use the Product in any manner prohibited by United States export laws, restrictions or regulations;(xi) Transmit the Product electronically or allow access to the Product over a network or a public computer-based information system which permits access to a greater number of users than licensed by Licensee;(xii) Use the Product in multiple computer or multiple user arrangements unless that use is covered by a separate license for each computer or user; or(xiii) Rent, lease, or distribute or otherwise transfer possession of any copy of the Product to any third party. SNPs reported the following measures in HEDIS 2016: Please see the links below for the most recent SNP HEDIS Reports released by NCQA. NCQA holds a copyright in the measures and specifications and may rescind or alter these measures and specifications at any time. NCQA > 2022 Standards and Guidelines for the Accreditation of Health Plans (epub) 2022 HP Standards and Guidelines (epub) Number Of Users Single User: $410.00 2-4 Users: $1,150.00 5-10 Users: $2,670.00 11-20 Users: $4,920.00 21-30 Users: $7,380.00 31-50 Users: $12,300.00 NCQA PUBLICATION LICENSE AGREEMENT Licensee Representation and WarrantyLicensee represents and warrants to NCQA that this License Agreement shall be binding on Licensee, and, unless Licensee is an individual, Licensee represents and warrants that this License Agreement was executed by an authorized signatory of Licensee with the authority to enter into binding agreements on behalf of Licensee. Eligible organizations: Note: Members refers to membership of clients and organizations. Data allow identification of performance gaps and establishment of realistic targets for improvement. 4 0 obj <> You will be prompted to log in to your NCQA account. NCQA Utilization Management Accreditation is designed to ensure that organizations can consistently make appropriate and timely decisions. NCQAs failure to exercise or enforce any right or power under this License Agreement shall not constitute a waiver of such right or power. This License Agreement may not be modified by Licensee except upon mutual agreement by the parties in writing, signed by an authorized representative of NCQA. ,xbcb({h`>0-810d|2?k=7_u>7o6'U BnvzEe/. =rtlh.ew\^7GqsUbefrNd@yE\z1{#~vlVV>8;"s%!KQP8v %EXe dRq[aq`$p0b2d&Fdmm0QfEJIz}33*g-yQV6hN}xmQHYBvF*.hvmrm40g4h2f NCQA Accreditation: MCOs are required to be accredited, which necessitates continuous analysis of opportunities to improve coordination of care. ePub: A downloadable PDF version of the standards, Web-based: A license to access a web-based version of the standards through IRT. Unauthorized internal distribution of the Product and materials therein - beyond the number of Licensed Users by your organization - is prohibited. %PDF-1.6 % h{koG_G X4!iIZHm*)yn`Pxq|f-gZ3^IU\E,V/pfs-Qjl2j %X2c>>/i1f2<5GBghj,em@?}as_o.]~wTv]p>]{w?/&F~tZyF0}#?mVononW?72PwglMU8:2_vT~wi?sv/ r[7VjQ^x|;X77nM|"zyu,pq?$Wg+[}ry$x?~6-n~]ts~V1Ww?\mvJBS |{i{sV~ ,'|^]+:Y>R>}/Z (m`3.bL,@VE~21"dm([P `[y~qx>*S:`iV81~RO/O.0] }x^P#rbriy+#B8},-5%(muE}wuk#;3#}?OyLrm4|8:p:w~|f:Nmr{G\x(]`u{^cU,N]v5L;FK/WD\oX{*9)Pb,Y%'8:VWD 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. <> NCQA maintains adatabase of frequently asked questionsabout NCQA standards and interpretation of requirements. III. EFFECTIVE FOR SURVEYS WITH A START DATE OF JULY 1, 2020 ONWARD. 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. THE USE OF THE DATA WITHIN ANY PRODUCT IS ENTIRELY AT LICENSEES OWN RISK AND NCQA SHALL HAVE NO LIABILITY OR RESPONSIBILITY THEREFOR. Organizations must meet program criteria to pursue this accreditation. 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. II. See our, Due to COVID-19, NCQA will not release 2020 Health Plan Ratings for any product line. Limitation of LiabilityIN NO EVENT WILL NCQA BE LIABLE FOR ANY CONSEQUENTIAL, PUNITIVE, SPECIAL, INCIDENTAL, EXEMPLARY, INDIRECT OR OTHER SIMILAR DAMAGES, INCLUDING, WITHOUT LIMITATION, LOSS OR INACCURACY OF DATA, LOSS OF BUSINESS OR LOSS OF PROFITS ARISING OUT OF THE USE OR INABILITY TO USE THE PRODUCT, EVEN IF NCQA HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, AND IN NO EVENT SHALL NCQA BE RESPONSIBLE FOR ANY CLAIMS OF THIRD PARTIES. The headings contained in this License Agreement are for reference only and shall not affect the meaning or interpretation of this License Agreement. AssignmentLicensee shall not assign this License Agreement without the written consent of NCQA. IV. More than 12,000 practices (with more than 60,000 clinicians) are recognized by NCQA. Share this page with a friend or colleague by Email. XVII. 3 0 obj 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. Save your favorite pages and receive notifications whenever theyre updated. 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. NCQA makes updates or clarifications to Standards & Guidelines several times per year, as needed. .gov This Case Management publication outlines standards and features explanations and examples of how to meet the standards, scoring guidelines, points and certification outcomes. XIV. hb```f``*e`e` ",l@qA $2>Qs*C>2bf.6AB^;x1K_YlQlqc]>'@2'oSQ"|*x TdB^9WACh0F @Xn^xJps Copyright 2023 National Committee for Quality Assurance. 59CNByOzdm Read this License Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. Focus areas to ensure high quality. SurvivalThe provisions of Sections V, VII and VIII of this License Agreement shall survive the termination of this License Agreement. Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store. https:// Licensee means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the License Agreement terms below. ) Contact and Notices. X. SeverabilityIf any portion of this License Agreement is determined by a court of competent jurisdiction or any appropriate legislature to be wholly or partially unenforceable, for any reason, such unenforceability shall not affect the balance hereof. The Product is being licensed (not sold) to you, the Licensee (the License). Unauthorized internal distribution of the Product and materials therein - beyond the number of Licensed Users by your organization - is prohibited. HEDIS VSDs are made separately available, at no cost, in electronic format. h\AN@E27dRTQbQB*=vX{r$e K8Z+*;e_?St*[|e[o-;/6MpnC\Hdy rL|LIr2e_D,F1+^1W+s N$oK)R493{py #xtV>zxk13No9:C_ eH__C/WpGOav4 Upon termination of this License Agreement, all rights under this License Agreement, including the license granted to Licensee, will cease. 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). 2F%At/|b^-x({N&R26y H4>1=.~MClx-ikqGbg NCQA does not within the standards of our HIPAA Nothing included in NCQA standards are intended to conflict with an organization's responsibility to comply with l and state laws as it relates to privacy, security and confidentiality. wq43-TY^yTk$8JkMVj$MX:v2Zz;I;Y; hb```e``@(\>3,`a\Tf CAAPV$wCMm]uc9MSYtr;lI^@fnlna?NUIJj2@{y8B \]$g/Qe SrO$[@,g^P^^D;L@9#P` $;PM g,bupG30zoebnc/48,Fyr\0pG*300`4 Should Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. NCQA typically releases the survey tool at the same time it releases the standards. Official websites use .govA HEDIS VSDs are made separately available, at no cost, in electronic format. Delegation Best Practices Frank Stelling October 2019 5 Predelegation Evaluation NCQA reviews delegation arrangements initiated in the look-back period Score of 100% for NCQA-accredited or NCQA-certified delegates Best Practice: Evaluate delegate's experience with NCQA requirements, contact other clients NOTE: This License Agreement is null and void as related to the following NCQA Products (as such term is defined in Section I below): Risk Adjustment Tables, HEDIS Medication List Directory and CA DHCS QIP (any) Edition of HEDIS Digital Measures Bundle For ECDS Reporting. NCQA will release the 2021 Health Plan Ratings (HPR) for all product lines in September 2021. A Licensed User must be using the Product under the License and solely on behalf of the Licensee. stream [UuKo-3q/pEqx".z+EX,?+"'MNb)=)V+QK,gK!^}@]^,\J N8AB[0|7x MbN_M9[1g05KL :7f>~C|Vp$'*.ljYZ\l:ZS|s{No#mi',tg,j>0~Y=%B-}xi(~ hA_wfsb { The following activities are expressly prohibited in connection with the use of the Product under this License Agreement: (i) No individual or entity may use the Product to evaluate another organization against NCQA standards, except as part of Licensees internal preparation for an NCQA survey or review; and(ii) Licensee may not allow a third party to view or use the Product. The following activities are expressly prohibited in connection with the use of the Product under this License Agreement: (i) No individual or entity may use the Product to evaluate another organization against NCQA standards, except as part of Licensees internal preparation for an NCQA survey or review; and(ii) Licensee may not allow a third party to view or use the Product. Prohibited Use AcknowledgmentAn organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. The 2020 HP Survey Tool was released on March 30, 2020. 2019 Clinical Quality Measure Flow Narrative for Quality ID #236 NQF #0018: Controlling High Blood Pressure <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Information. associated checkbox/button and moving forward to ensure that organizations can make..., at no cost, in electronic format designed to ensure that organizations can consistently make and. Members refers to membership of clients and organizations SURVEYS WITH a friend or colleague by Email these. An agent or consultant of a Licensee RISK and NCQA shall have no LIABILITY or RESPONSIBILITY THEREFOR purpose obtaining! Licensee ( the License subject to the practice to determine survey tool at the same time it releases survey! 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And specifications and may rescind or alter these measures and specifications at any time SOFTWARE REQUIRED in WITH. Release 2020 Health Plan Ratings ( HPR ) for all Product lines September.