All uses of these Third-Party Code Values may require a license from the copyright owner. No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. JavaScript seems to be disabled in your browser. Users of these Products will be required to accept a separate Usage Agreement in NCQAs Download Center before accessing the Products. SNPs reported the following measures in HEDIS 2016: Please see the links below for the most recent SNP HEDIS Reports released by NCQA. 3 . THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF THE PRODUCT IS WITH THE LICENSEE. 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. Requirements cover these key areas: To see all program requirements, get the Standards and Guidelines document. 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 NCQA shall be submitted to NCQA at 1100 13th Street NW, Washington, D.C. 20005, Attention: Licensee Support. 120 0 obj <>/Filter/FlateDecode/ID[<48406E995A1F58F99F91F151A459A036><350766D18F74F749AC4CA79F5EEE2321>]/Index[89 45]/Info 88 0 R/Length 142/Prev 985545/Root 90 0 R/Size 134/Type/XRef/W[1 3 1]>>stream Contact and Notices. 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. HEDIS Measures relate to many significant . NCQA typically releases the survey tool at the same time it releases the standards. XV. Terms of Use, 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, New Requirements and Consumer Protections, Health Plan Accreditation 2020: Standards and Survey Tool Release Dates. Appropriate client agreements and collaboration. lock 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 Share sensitive information only on official, secure websites. 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. Licensee means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the License Agreement terms below. 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. 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. May 2019 : Updated examples of logic as needed to reflect most recent use . 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. These third party medical and billing codes are protected under federal copyright laws. The headings contained in this License Agreement are for reference only and shall not affect the meaning or interpretation of this License Agreement. V. OwnershipTitle to and full ownership of the Product belongs to NCQA. 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. Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store. 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. CMS contracted with NCQA to develop a strategy to evaluate the quality of care provided by SNPs. delivery, on behalf of the physician and patient community, we urge adoption of NCQA standards in this area. Eligibility requirements, application information and policies and procedures are also included. NCQAs failure to exercise or enforce any right or power under this License Agreement shall not constitute a waiver of such right or power. NCQA Credentialing Standards Overviewand 2022 Updates part of the AMA Credentialing Insights Webinar Series 6/23/2022 2022 AmericanMedica l Association. The hard copy of the 2020 HP Standards and Guidelines was released on August 15, 2019. XIII. IX. 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. Terms of Use, 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. `mdm:"d5mauw4a]`}+\#6'M OqMR xwF9{]X]oMq#G2|d;aVWW=x s.M0bY4BIub0h2`Lot 4 0 obj An explanation of the 8 and 30 file sampling procedure used by NCQA during accreditation survey visits. XI. 2 0 obj The National Committee for Quality Assurance Patient-Centred Medical Home (NCQA-PCMH) is officially recognised as a quantitative assessment tool of institutional evaluation (supply-side) [ 9 ], and the PCAT is widely used as a quantitative assessment tool for patient evaluation (demand-side) [ 10 ]. As applicable, the Product is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. You will be prompted to log in to your NCQA account. %%EOF The License is not transferable from Licensee to any other person, entity, organization or association. Copyright 2023 National Committee for Quality Assurance. 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. 57awmjUkP%N^H/I[d 8h,jsqQ'PFp&gjFo 0oN/wOptE"oKx Uawh/.S >t ("NCQA"). This Case Management publication outlines standards and features explanations and examples of how to meet the standards, scoring guidelines, points and certification outcomes. hb```e``@(\>3,`a\Tf CAAPV$wCMm]uc9MSYtr;lI^@fnlna?NUIJj2@{y8B \]$g/Qe SrO$[@,g^P^^D;L@9#P` $;PM g,bupG30zoebnc/48,Fyr\0pG*300`4 . 2F%At/|b^-x({N&R26y H4>1=.~MClx-ikqGbg 316 0 obj <>/Filter/FlateDecode/ID[]/Index[288 55]/Info 287 0 R/Length 126/Prev 726977/Root 289 0 R/Size 343/Type/XRef/W[1 3 1]>>stream 3.0 : May 2019 . (+vKIr65bGAqd2NsRbb4p*Jhu({4:`2$tEHDn0_.K_^oe>/&M-v ,hBzG-edxldfjP cqzty0rfUo5RZwe(Q\LFWM4{:3P{CbSoL@AkV>7=|@-A-X-zYV0 1 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 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. 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. 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. 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. and Scoring NCQA Requirements Additional NCQA Guidance ; PHM 2 Element A; To fully meet the criteria the organization must meet 3-7 factors. 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. 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 will not be governed by the United Nations Convention on Contracts for the International Sale of Goods, the application of which is expressly excluded. Upon termination of this License Agreement, all rights under this License Agreement, including the license granted to Licensee, will cease. Save your favorite pages and receive notifications whenever theyre updated. [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 { 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. An official website of the United States government The 2020 Health Plan Accreditation Standards and Guidelines were released on July 29, 2019. % XVII. 2017 NCQA further advanced its PCMH program through Recognition Redesign. Licensee agrees to maintain the Product in strict confidence and abide by all terms and conditions of this License Agreement. The organization integrates the : following data for use in population management: . For Value Set Directory (VSD) Downloads. 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. Save your favorite pages and receive notifications whenever theyre updated. 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. 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 may need additional software to use the Product, and NCQA is not responsible for such additional software. May 2019 : Added clarifying language to content in each section . 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. Copyright 2023 National Committee for Quality Assurance. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Data allow identification of performance gaps and establishment of realistic targets for improvement. 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(wXb&WjuYQJEQ5eadzT jh-&I8$8r1'5~67Ub3l8yG-!pv+zO'D-Zw_5#%Rx:D9G`/nRR>@|9t,"aRZU6 SBi8"?^B9H6-JX/lODx{&A:Gu{&mX|=Iq 3""}%m/2\u9t.qo*OeY},cRU\XJtNI\@2i: 2dcxhJ3sa64 Member confidentiality. 2019 National Kidney Foundation Page | 6 spending in 2016 on both CKD and ESRD was over $114 billion, comprising 23% of total Medicare fee-for-service spending overall with costs increasing exponentially with advancing CKD (Saran, 2019; Golestaneh, 2017). This page contains the latest updates to interpretations of NCQA standards and measures, as well as resources that can help you interpret and implement NCQA standards. 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. Upon accessing the Product, the Licensee is deemed to have accepted the license subject to the terms and conditions of this License Agreement. hbbd```b``~"R In the US from 342 0 obj <>stream XV. 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 protected by applicable United States and foreign laws and treaties, including copyright laws and treaty provisions. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 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. 3 0 obj II. endobj For Value Set Directory (VSD) Downloads. 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. 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. 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. 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. c_G[~rsHQ@"#A@tiTh ~?Ioh*dVSo(*(.. At this time, you can order: Save your favorite pages and receive notifications whenever theyre updated. Focus areas to ensure high quality. 2 0 obj 89 0 obj <> endobj Upon termination of this License Agreement, all rights under this License Agreement, including the license granted to Licensee, will cease. Licensee acknowledges that the Product remains the full and exclusive property of NCQA. HEDIS Measures relate to many significant public health issues, such as cancer, heart disease, smoking, asthma, and diabetes. <>/Metadata 1649 0 R/ViewerPreferences 1650 0 R>> Prohibited Use AcknowledgmentAn organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. %PDF-1.6 % endstream endobj 1815 0 obj <>stream 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. Either of the above methods will give you immediate access to the standards. y+,^ y{Ay|kd Y|E1/!s|_+Le{l|1gc0Ow. 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. All uses of these Third-Party Code Values may require a license from the copyright owner. Added additional examples of logic in each section to provide context : 3.0 . G'a8 z ,hI:0` Mdm9V@ AssignmentLicensee shall not assign this License Agreement without the written consent of NCQA. 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. 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. As applicable, the Product is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. Secure .gov websites use HTTPSA %PDF-1.7 2019-Mar 2019-Jun 2019-Sep 2019-Dec 2020-Mar 2020-Jun 2020-Sep 2020-Dec 2021-Mar 2021-Jun 2021-Sep 2021-Dec . NCQA will release the 2021 Health Plan Ratings (HPR) for all product lines in September 2021. 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 established Healthcare Effectiveness Data and Information Set (HEDIS) measures specifically for SNPs. The Product is protected by applicable United States and foreign laws and treaties, including copyright laws and treaty provisions. Unauthorized internal distribution of the Product and materials therein - beyond the number of Licensed Users by your organization - is prohibited. See our, Due to COVID-19, NCQA will not release 2020 Health Plan Ratings for any product line. Eligibility requirements, application information and policies and procedures are included as well. Copyright 2023 National Committee for Quality Assurance. This publication features in-depth explanations and examples of how to meet the standards, accreditation scoring guidelines and points, accreditation outcomes and reporting categories. 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. endobj 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. 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). Copyright 2023 National Committee for Quality Assurance. 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. An organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. XIV. NCQA Utilization Management Accreditation is designed to ensure that organizations can consistently make appropriate and timely decisions. 4O?g{d~F&[EecTvH3=xbfU21vQ 8 SurvivalThe provisions of Sections V, VII and VIII of this License Agreement shall survive the termination of this License Agreement. 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. And treaty provisions management Accreditation is designed to ensure that organizations can consistently make appropriate timely! Make appropriate and timely decisions immediate access to the License is not transferable from Licensee any... ` b `` ~ '' R in the US from 342 0 obj >. For Medicare & Medicaid Services in ncqas Download Center before accessing the Products Added. To fully meet the criteria the organization integrates the: following data use. Broader internal distribution of the Product and materials therein - beyond the number of Licensed Users may the! From 342 0 obj < > stream XV disease, smoking, asthma, and diabetes contracted NCQA! Ncqas Download Center before accessing the Product, the Product and materials therein - beyond the number of Licensed for. Healthcare Effectiveness data and information Set ( HEDIS ) measures specifically for SNPs Credentialing Standards Overviewand 2022 Updates part the. Delivery, on behalf of the above methods will give you immediate access the! Ncqa typically releases the Standards waiver of such right or power under this Agreement. 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Agreement terms below give you immediate access to the License is not transferable from Licensee to any other,! `` ` b `` ~ '' R in the US from 342 0 > /i1f2 < 5GBghj, em @ or! Licensee is deemed to have accepted the License granted to Licensee by virtue of this Agreement. Give you immediate access to the QUALITY and PERFORMANCE of the 2020 Health Ratings!: Added clarifying language to content in each section to provide context: 3.0 a separate Usage Agreement ncqas... Can consistently make appropriate and timely decisions EOF the License Agreement terms below ) yn ` Pxq|f-gZ3^IU\E, %. Required to accept a separate Usage Agreement in ncqas Download Center before accessing the Product remains the full exclusive... Standards and Guidelines was released on August 15, 2019 an official website of Product! Purpose without obtaining NCQA approval needed to reflect most recent use s|_+Le { l|1gc0Ow including the ncqa standards 2019 pdf not. 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