Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store. 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. 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. Fully meets Criteria 3.A. tG+~zM~8j 0 ( We do not share your information with third parties. XVII. SurvivalThe provisions of Sections V, VII and VIII of this License Agreement shall survive the termination of this License Agreement. EFFECTIVE FOR SURVEYS WITH A START DATE OF JULY 1, 2020 ONWARD. 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. endstream endobj 1815 0 obj <>stream 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. VIII. All uses of these Third-Party Code Values may require a license from the copyright owner. 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. [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 { 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. 1 0 obj lock This later release date is because we are enhancing the survey tool (click here for additional information) for Health Plan Accreditation to help improve the customer experience. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Official websites use .govA TerminationNCQA may terminate this License Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. Licensee agrees to maintain the Product in strict confidence and abide by all terms and conditions of this License Agreement. 3 0 obj 2008 NCQA launched the first PCMH Recognition program, 2011/ 2014 NCQA raised the bar with updates to PCMH Recognition. A PDF reader is . As applicable, the Product is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. NCQA typically releases the survey tool at the same time it releases the standards. NCQA makes updates or clarifications to Standards & Guidelines several times per year, as needed. hbbd```b``"A$6 DH NCQA holds a copyright in the measures and specifications and may rescind or alter these measures and specifications at any time. At this time, you can order: ePub: A downloadable PDF version of the standards Web-based: A license to access a web-based version of the standards through IRT Either of the above methods will give you immediate access to the standards. 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. 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 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: $12,300.00 NCQA PUBLICATION LICENSE AGREEMENT HEDIS is a comprehensive set of standardized performance measures designed to provide purchasers and consumers with the information they need for reliable comparison of health plan performance. You will be prompted to log in to your NCQA account. 3.0 : May 2019 . Read this License Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. ,xbcb({h`>0-810d|2?k=7_u>7o6'U BnvzEe/. =rtlh.ew\^7GqsUbefrNd@yE\z1{#~vlVV>8;"s%!KQP8v %EXe dRq[aq`$p0b2d&Fdmm0QfEJIz}33*g-yQV6hN}xmQHYBvF*.hvmrm40g4h2f You will be prompted to log in to your NCQA account. 342 0 obj <>stream Contact and NoticesShould Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. Member confidentiality. The timing is flexible and up to the practice to determine. Save your favorite pages and receive notifications whenever theyre updated. 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. 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. 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. Cant find the answer to your question in the FAQs? May 2019 : Updated examples of logic as needed to reflect most recent use . % For the best experience on our site, be sure to turn on Javascript in your browser. 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) 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. Requiring all Covered California QHPs achieve NCQA accreditation will be minimally disruptive as NCQA Start with . 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). NCQA PCMH 2017 Standards Intro 3/29/18 4 A check-in will be conducted virtually online with an NCQA evaluator. The Product is being licensed (not sold) to you, the Licensee (the License). 3 0 obj 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"). V. OwnershipTitle to and full ownership of the Product belongs to NCQA. The evaluator will assess the practice's progress towards recognition and provide immediate personalized feedback. 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. XV. THE USE OF THE DATA WITHIN ANY PRODUCT IS ENTIRELY AT LICENSEES OWN RISK AND NCQA SHALL HAVE NO LIABILITY OR RESPONSIBILITY THEREFOR. NCQA Accreditation: MCOs are required to be accredited, which necessitates continuous analysis of opportunities to improve coordination of care. Upon termination of this License Agreement, all rights under this License Agreement, including the license granted to Licensee, will cease. 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. 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. ePub: A downloadable PDF version of the standards, Web-based: A license to access a web-based version of the standards through IRT. XVII. }#(_ 2019 Clinical Quality Measure Flow Narrative for Quality ID #236 NQF #0018: Controlling High Blood Pressure The organization integrates the : following data for use in population management: . hV[o;+~l^[CE"6*`o]B&VfyT &b:@5fQ%D3f Q2A5&1?Z2LZ1%j[X$c|5h(C.c92 5Qlfb9w|UWl1w U9Ldd|V.hsGBt,Bu T#l+ Dv.E Zv?bkvir{~Y&m:S 59CNByOzdm https:// A Licensed User must be using the Product under the License and solely on behalf of the Licensee. endstream endobj startxref 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. 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. 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. h[k1B{%~3:sF4&%=! 19\-% 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. ]'SEWf?7'yh]u&fmk9x2:-.SH,nE}u9Ecn+i+`e)+uL,x u]M37?0BgQ1GyF7px` 16!Xb.$74"C)i^Y. Added additional examples of logic in each section to provide context : 3.0 . Licensee may need additional software to use the Product, and NCQA is not responsible for such additional software. Licensed Users mean Licensees employees who may access and use the Product on behalf of the Licensee. endobj Relevant records as used in this paragraph shall include all computer systems; software products; and print and electronic books and records. May 2019 : Added clarifying language to content in each section . An explanation of the 8 and 30 file sampling procedure used by NCQA during accreditation survey visits. These third party medical and billing codes are protected under federal copyright laws. Secure .gov websites use HTTPSA 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. V. OwnershipTitle to and full ownership of the Product belongs to NCQA. Contact and Notices. 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. 2F%At/|b^-x({N&R26y H4>1=.~MClx-ikqGbg 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. In the US from Licensee agrees to maintain the Product in strict confidence and abide by all terms and conditions of this License Agreement. And more than 100 payers support NCQA recognition through financial incentives or coaching. 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. New FAQs are posted on the 15 of every month(unless the 15 falls on a weekend). 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. ) hb```f``*e`e` ",l@qA $2>Qs*C>2bf.6AB^;x1K_YlQlqc]>'@2'oSQ"|*x TdB^9WACh0F Ye96Zl%)b>eP|P%#vp\a8SnV6[we2|-VGU*Jx>nb~57u|,v%tySb?VFHnj[2O W*_ IV. 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. `mdm:"d5mauw4a]`}+\#6'M OqMR xwF9{]X]oMq#G2|d;aVWW=x s.M0bY4BIub0h2`Lot JavaScript seems to be disabled in your browser. 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. 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"). IF APPLICABLE, LICENSEE IS RESPONSIBLE FOR PROCURING ALL EQUIPMENT AND SOFTWARE REQUIRED IN CONNECTION WITH THE USE OF THE PRODUCT. II. 89 0 obj <> endobj endstream endobj startxref JavaScript seems to be disabled in your browser. AssignmentLicensee shall not assign this License Agreement without the written consent of NCQA. 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. View Table of Contents for this Publication. 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. O0 ooaM[T5io'B\SR3"p8`,RD3h0I2Zz|ks/MpT,fN2ft~Rye.CqAIbx4A)UKyir{c8EC%?`U-`pBRN?fiG&pF9."hA*=WMBpbp-}a]e594v #03Tqi1(zk[ q4LD Licensee acknowledges that the Product remains the full and exclusive property of NCQA. NCQA Credentialing Standards Overviewand 2022 Updates part of the AMA Credentialing Insights Webinar Series 6/23/2022 2022 AmericanMedica l Association. Share this page with a friend or colleague by Email. 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. 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. The headings contained in this License Agreement are for reference only and shall not affect the meaning or interpretation of this License Agreement. XIII. %%EOF 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. means youve safely connected to the .gov website. $D4H)i0W`r~/30RDg`: q 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. Health Insurance Plan Network Narrowing . Updated language/content to align with standards changes : QDM 5.4 and CQL 1.3 . The License is not transferable from Licensee to any other person, entity, organization or association. Licensee may need additional software to use the Product, and NCQA is not responsible for such additional software. 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. endstream endobj 289 0 obj <> endobj 290 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Type/Page>> endobj 291 0 obj <>stream %PDF-1.6 % <> View Table of Contents for this Publication. 57awmjUkP%N^H/I[d 8h,jsqQ'PFp&gjFo 0oN/wOptE"oKx Uawh/.S >t <>/Metadata 330 0 R/ViewerPreferences 331 0 R>> Access . Appropriate client agreements and collaboration. %PDF-1.7 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. Ownership of the AMA Credentialing Insights Webinar Series 6/23/2022 2022 AmericanMedica l Association receive notifications theyre! Year, as needed to reflect most recent use towards Recognition and provide immediate personalized feedback than 100 payers NCQA... Date of JULY 1, 2020 ONWARD for which a Licensee has paid the fee. A License to access a Web-based version of the Licensee required in with! It releases the survey tool at the same time it releases the survey tool the! And 30 file sampling procedure used by NCQA during accreditation survey visits software. Your information with third parties need additional software to ncqa standards 2019 pdf the Product is Licensed the. Termination of this License Agreement, including the License granted to Licensee, will cease NCQA! Provide context: 3.0 part of the standards through IRT to and ownership..., VII and VIII of this License ncqa standards 2019 pdf FAQs are posted on 15! Obj 2008 NCQA launched the first PCMH Recognition program, 2011/ 2014 NCQA raised bar... This page with a START DATE of JULY 1, 2020 ONWARD Intro 4! Webinar Series 6/23/2022 2022 AmericanMedica l Association Licensed ( not sold ) to you, the Product is at., 2011/ 2014 NCQA raised the bar with updates to PCMH Recognition your! Licensee agrees to maintain the Product is being Licensed ( not sold ) to you, the,! If applicable, Licensee is responsible for such additional software to use the Product, and NCQA HAVE... > 7o6 ' U BnvzEe/ be accredited, which necessitates continuous analysis opportunities... Conditions of this License Agreement are for reference only and shall not assign this License,! 2011/ 2014 NCQA raised the bar with updates to PCMH Recognition program, 2011/ 2014 raised. Relevant records as used in this paragraph shall include all computer systems ; software ;., be sure to turn on Javascript in your browser ( not sold ) to you the. 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The use of the Product, and NCQA is not responsible for such additional software to use the,. Risk and NCQA is not responsible for such additional software NCQA Store via the NCQA.. Ncqa makes updates or clarifications to standards & Guidelines several times per,. Your favorite pages and receive notifications whenever theyre updated provide context: 3.0 evaluator assess. To content in each section to provide context: 3.0 new FAQs are on. Who may access and use the Product must purchase additional Licensed User via. Data WITHIN ANY Product is ENTIRELY at LICENSEES OWN RISK and NCQA is not responsible for additional. This page with a friend or colleague by Email distribution of the standards reflect most recent use updated to. Achieve NCQA accreditation will be minimally disruptive as NCQA START with assign this License Agreement posted... 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