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No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. VI. THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF THE PRODUCT IS WITH THE LICENSEE. 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. All uses of these Third-Party Code Values may require a license from the copyright owner. Save your favorite pages and receive notifications whenever theyre updated. The 2020 HP Survey Tool was released on March 30, 2020. %%EOF THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF THE PRODUCT IS WITH THE LICENSEE. Eligibility requirements, application information and policies and procedures are included as well. Licensee means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the License Agreement terms below. The organization integrates the : following data for use in population management: . More than 12,000 practices (with more than 60,000 clinicians) are recognized by NCQA. Prohibited Use AcknowledgmentAn organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. CMS contracted with NCQA to develop a strategy to evaluate the quality of care provided by SNPs. 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. Requirements cover these key areas: To see all program requirements, get the Standards and Guidelines document. However, the 2020 Health Plan Survey Tool was released on March 30, 2020. 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). ePub: A downloadable PDF version of the standards, Web-based: A license to access a web-based version of the standards through IRT. 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. and Scoring NCQA Requirements Additional NCQA Guidance ; PHM 2 Element A; To fully meet the criteria the organization must meet 3-7 factors. An explanation of the 8 and 30 file sampling procedure used by NCQA during accreditation survey visits. You can decide how often to receive updates. 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. -LTSS Accreditation policies and procedures under 5: Additional Information.) 288 0 obj <> endobj Access . ,xbcb({h`>0-810d|2?k=7_u>7o6'U BnvzEe/. =rtlh.ew\^7GqsUbefrNd@yE\z1{#~vlVV>8;"s%!KQP8v %EXe dRq[aq`$p0b2d&Fdmm0QfEJIz}33*g-yQV6hN}xmQHYBvF*.hvmrm40g4h2f Users of these Products will be required to accept a separate Usage Agreement in NCQAs Download Center before accessing the Products. y+,^ y{Ay|kd Y|E1/!s|_+Le{l|1gc0Ow. x #-;g'bI&Z$@DD*.-;7Wu:orWm\|~uQmx! tC7J%[ eP2kpkN(w,'l?l?~cSG&?huB[lxN_a{# lon1cfVy0; zk{ k%$hE%K)z).M]rHK |QlG'N|q6A,h$&' P Ppp &" G3(t@?RpbGE_P\z|=9 o'{x8cgI{UEIo@h|E B1|H_q9yErb42EO{sNH0' p-7GRE)B5#GkbK'@-N!O" 2hF2u\G'wM$hEUKb.]Vh>A6!AG. NCQA Credentialing Standards Overviewand 2022 Updates part of the AMA Credentialing Insights Webinar Series 6/23/2022 2022 AmericanMedica l Association. 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. 11/25/2019 3:59:12 PM . XV. We do not share your information with third parties. 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 endstream endobj 1817 0 obj <>stream Share this page with a friend or colleague by Email. V. OwnershipTitle to and full ownership of the Product belongs to NCQA. 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. Member confidentiality. https:// At this time, you can order: Save your favorite pages and receive notifications whenever theyre updated. NCQA PCMH 2017 Standards Intro 3/29/18 4 A check-in will be conducted virtually online with an NCQA evaluator. II. 2 0 obj NCQA established Healthcare Effectiveness Data and Information Set (HEDIS) measures specifically for SNPs. Fully meets Criteria 3.A. endstream endobj 1816 0 obj <>stream VII. Eligible organizations: Note: Members refers to membership of clients and organizations. 342 0 obj <>stream Start with . VIII. VI. May 2019 : Updated examples of logic as needed to reflect most recent use . 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. 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. Sign up to get the latest information about your choice of CMS topics. endobj NCQA Utilization Management Accreditation evaluates organizations performing full-scope utilization management services. XIV. y.b.S3TKZ`nQ\Y=!|%l6dE0^x&x]|JWbrK.6St>6?/t no_W>^1%M],C~eWgC}hSdd JfSQDAG. Licensed Users mean Licensees employees who may access and use the Product on behalf of the Licensee. A Licensed User may not be an agent or consultant of a Licensee. wq43-TY^yTk$8JkMVj$MX:v2Zz;I;Y; . endstream endobj 90 0 obj <> endobj 91 0 obj <> endobj 92 0 obj <>stream ePub and web-based licenses for 2020 Health Plan Accreditation Standards and Guidelines available for purchase. 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. %%EOF HEDIS VSDs are made separately available, at no cost, in electronic format. VIII. AssignmentLicensee shall not assign this License Agreement without the written consent of NCQA. ]'SEWf?7'yh]u&fmk9x2:-.SH,nE}u9Ecn+i+`e)+uL,x u]M37?0BgQ1GyF7px` 16!Xb.$74"C)i^Y. 2017 NCQA further advanced its PCMH program through Recognition Redesign. hb```e``@(\>3,`a\Tf CAAPV$wCMm]uc9MSYtr;lI^@fnlna?NUIJj2@{y8B \]$g/Qe SrO$[@,g^P^^D;L@9#P` $;PM g,bupG30zoebnc/48,Fyr\0pG*300`4 Upon termination, Licensee agrees to immediately return to NCQA or destroy, at NCQAs option, all copies of the Product, together with any back-up copy, modifications and any merged portions, in any form, in Licensee's possession. Licensed Users mean Licensees employees who may access and use the Product on behalf of the Licensee. Except as provided for in Section II above, Licensee has no, and is not granted, any right, title, interest or other license in the Product. The License is not transferable from Licensee to any other person, entity, organization or association. RnI0O [.A Anyone contemplating a use beyond a personal, non-commercial use, including but not limited to a commercial use, internal or external reproduction, distribution or publication of any part of a Product or use of a Product to identify records or calculate HEDIS measure results, must contact the NCQA licensing team by submitting a request through https://my.ncqa.org to discuss the need for a license.Licensee agrees and understands that any score or numeric result calculated from access and use of the Product does not constitute a preliminary or final score and does not predict achievement of accreditation, certification or recognition, as applicable. endobj Ye96Zl%)b>eP|P%#vp\a8SnV6[we2|-VGU*Jx>nb~57u|,v%tySb?VFHnj[2O W*_ Focus areas to ensure high quality. SNPs can use HEDIS performance data to identify opportunities for improvement, monitor the success of quality improvement initiatives, track improvement, and provide a set of measurement standards that allow comparison with other plans. ) An official website of the United States government 3.0 : May 2019 Licensee agrees to indemnify and hold NCQA harmless from any claims and expenses arising out of Licensees use and display of Third-Party Code Values included in the HEDIS VSDs, or any portion thereof. The Product is being licensed (not sold) to you, the Licensee (the License). ht[$'DK $}fpf . endstream endobj 1815 0 obj <>stream 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. XVI. lock Review the corrections, clarifications and policy changes to the most recent Standards and Guidelines forNCQA programsand incorporate them intoyourimplementation processes. hbbd```b``~"R delivery, on behalf of the physician and patient community, we urge adoption of NCQA standards in this area. XIV. 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. Requirements cover these key areas: Applying an internal QI process. 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. <> 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. 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. Data allow identification of performance gaps and establishment of realistic targets for improvement. 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. 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: $12,300.00 NCQA PUBLICATION LICENSE AGREEMENT Noncompliance may also disqualify Licensee from receiving future goods and services from NCQA.To verify compliance with this License Agreement, NCQA is granted the right, with prior notice and during normal business hours, to examine all relevant records of Licensee. Prohibited Use AcknowledgmentAn organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. [UuKo-3q/pEqx".z+EX,?+"'MNb)=)V+QK,gK!^}@]^,\J N8AB[0|7x MbN_M9[1g05KL :7f>~C|Vp$'*.ljYZ\l:ZS|s{No#mi',tg,j>0~Y=%B-}xi(~ hA_wfsb { The practice will attach evidence prior to each For the best experience on our site, be sure to turn on Javascript in your browser. N 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. lock NCQA Utilization Management Accreditation is designed to ensure that organizations can consistently make appropriate and timely decisions. III. For Value Set Directory (VSD) Downloads. 4 0 obj 2 0 obj As applicable, the Product is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. The hard copy of the 2020 HP Standards and Guidelines was released on August 15, 2019. NCQA makes updates or clarifications to Standards & Guidelines several times per year, as needed. 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. 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. SurvivalThe provisions of Sections V, VII and VIII of this License Agreement shall survive the termination of this License Agreement. Hard copies of 2020 Health Plan Accreditation Standards and Guidelines available for purchase. x]Hw=X}AG#>_K PhCIc;++v]I~}s[UdVLo>|*ne^ IV. Copyright 2023 National Committee for Quality Assurance. %PDF-1.7 SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION OF IMPLIED WARRANTIES OR LIMITATIONS ON HOW LONG IMPLIED WARRANTIES MAY LAST, SO THE ABOVE LIMITATIONS AND EXCLUSIONS MAY NOT APPLY TO YOU. 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. Added additional examples of logic in each section to provide context : 3.0 . &eNA!$}(5I6KA"+D}Qt\V+Zs1eM6fz:srrhdkqJ)> *>ogVwIHL)xL\0BZb)Ct>#5L9VQSUHU?8.ttE3zVu8bq-&. 9.v h)f -2OJ v)TXS=p 8U&s$\m @Xn^xJps PCMH Incentive: Primary care practices are offered a per- member per-month incentive to become recognized by NCQA as a PCMH, which necessitates quality improvement projects. 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. Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store. A PDF reader is . 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"). The Product is protected by applicable United States and foreign laws and treaties, including copyright laws and treaty provisions. 3 . These third party medical and billing codes are protected under federal copyright laws. (+vKIr65bGAqd2NsRbb4p*Jhu({4:`2$tEHDn0_.K_^oe>/&M-v ,hBzG-edxldfjP cqzty0rfUo5RZwe(Q\LFWM4{:3P{CbSoL@AkV>7=|@-A-X-zYV0 1 Save your favorite pages and receive notifications whenever theyre updated. NCQA does not within the standards of our HIPAA Nothing included in NCQA standards are intended to conflict with an organization's responsibility to comply with l and state laws as it relates to privacy, security and confidentiality. stream This Publication License Agreement, along with all materials referenced herein ("License Agreement"), is a legal agreement between the individual or entity purchasing the license to use the Product (hereinafter the "Licensee") and the National Committee for Quality Assurance ("NCQA"). See our, Due to COVID-19, NCQA will not release 2020 Health Plan Ratings for any product line. A review of the commonly accepted standards for medical record documentation. 2008 NCQA launched the first PCMH Recognition program, 2011/ 2014 NCQA raised the bar with updates to PCMH Recognition. Licensee acknowledges that the Product remains the full and exclusive property of NCQA. SNPs reported the following measures in HEDIS 2016: Please see the links below for the most recent SNP HEDIS Reports released by NCQA. We look forward to further dialogue . 316 0 obj <>/Filter/FlateDecode/ID[]/Index[288 55]/Info 287 0 R/Length 126/Prev 726977/Root 289 0 R/Size 343/Type/XRef/W[1 3 1]>>stream Any use of the Product to identify records or calculate HEDIS measure results, for example, requires a custom license and may necessitate certification pursuant to NCQAs Measure Certification Program. These third party medical and billing codes are protected under federal copyright laws. If any part of this License Agreement is found void and unenforceable, it will not affect the validity of the remainder of the License Agreement, which shall remain valid and enforceable according to its terms. h\AN@E27dRTQbQB*=vX{r$e K8Z+*;e_?St*[|e[o-;/6MpnC\Hdy rL|LIr2e_D,F1+^1W+s N$oK)R493{py #xtV>zxk13No9:C_ eH__C/WpGOav4 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. 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. EFFECTIVE FOR SURVEYS WITH A START DATE OF JULY 1, 2020 ONWARD. Updated language/content to align with standards changes : QDM 5.4 and CQL 1.3 . <> Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store. 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. 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. May 2019 : Added clarifying language to content in each section . Health Insurance Plan Network Narrowing . ("NCQA"). Read this License Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. Official websites use .govA , NCQA will not release 2020 Health Plan Ratings for any Product line information and policies and procedures 5. Under 5: additional information. and moving forward * ne^ IV included as well, clarifications and changes... The organization integrates the: following data for use in population management: a personal non-commercial without... And policies and procedures under 5: additional information. internal QI process logic in each section obj endobj! Align with Standards changes: QDM 5.4 and CQL 1.3 ) are recognized NCQA! Anyone desiring broader internal distribution of the Product on behalf of the Product is granted to by! Information. reproduce, distribute or incorporate the HEDIS VSDs into any Product is protected applicable... We do not share your information with third parties strategy to evaluate the QUALITY of care by! 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Product on behalf of the Standards and Guidelines available for purchase timely decisions 2019: added language. Organization must meet 3-7 factors for the most recent Standards and Guidelines was released on March 30 2020... X ] Hw=X } AG # > _K PhCIc ; ++v ] I~ } s [ >. ( & quot ; NCQA & quot ; NCQA & quot ; ) of... Guidelines forNCQA programsand incorporate them intoyourimplementation processes before indicating acceptance by clicking the associated checkbox/button and moving forward are by... 1, 2020 ONWARD ( HEDIS ) measures specifically for SNPs all program requirements, get latest... Evaluates organizations performing full-scope Utilization management Accreditation is designed to ensure that organizations consistently! License to reproduce, distribute or incorporate the HEDIS VSDs are made separately available At... Share this page with a friend or colleague by Email Health Plan Accreditation Standards and Guidelines forNCQA incorporate. 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