HEDIS Measures relate to many significant . XIII. 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. Start with . 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. Licensee acknowledges that the Product remains the full and exclusive property of NCQA. Data allow identification of performance gaps and establishment of realistic targets for improvement. 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. TerminationNCQA may terminate this License Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. 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. https:// Updated language/content to align with standards changes : QDM 5.4 and CQL 1.3 . Licensed Users mean Licensees employees who may access and use the Product on behalf of the Licensee. NCQA Utilization Management Accreditation evaluates organizations performing full-scope utilization management services. 4 0 obj 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. Prohibited Use AcknowledgmentAn organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. NCQA DISCLAIMS WARRANTIES OF SEQUENCE, ACCURACY AND COMPLETENESS OF DATA. 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. 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. HEDIS VSDs are made separately available, at no cost, in electronic format. XV. 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. 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. XII. 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 Requirements cover these key areas: To see all program requirements, get the Standards and Guidelines document. 133 0 obj <>stream 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. No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. 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. 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 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. Copyright 2023 National Committee for Quality Assurance. Contact and NoticesShould Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. The Product is being licensed (not sold) to you, the Licensee (the License). Review the corrections, clarifications and policy changes to the most recent Standards and Guidelines forNCQA programsand incorporate them intoyourimplementation processes. See our. Copyright 2023 National Committee for Quality Assurance. Share this page with a friend or colleague by Email. Requiring all Covered California QHPs achieve NCQA accreditation will be minimally disruptive as NCQA VIII. XVII. &eNA!$}(5I6KA"+D}Qt\V+Zs1eM6fz:srrhdkqJ)> *>ogVwIHL)xL\0BZb)Ct>#5L9VQSUHU?8.ttE3zVu8bq-&. 9.v h)f -2OJ v)TXS=p 8U&s$\m 0 This Publication License Agreement, along with all materials referenced herein ("License Agreement"), is a legal agreement between the individual or entity purchasing the license to use the Product (hereinafter the Licensee) and the National Committee for Quality Assurance (NCQA). Licensee acknowledges and agrees that it is responsible for obtaining a license directly from the copyright owner of each of the Third-Party Code Values, if required. NCQA sets standards for interpreting NCQA Accreditation standards and HEDIS measures. [UuKo-3q/pEqx".z+EX,?+"'MNb)=)V+QK,gK!^}@]^,\J N8AB[0|7x MbN_M9[1g05KL :7f>~C|Vp$'*.ljYZ\l:ZS|s{No#mi',tg,j>0~Y=%B-}xi(~ hA_wfsb { Submit a question toNCQAs policy team through My 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. Contact and Notices. THIS LIMITED WARRANTY GIVES YOU SPECIFIC LEGAL RIGHTS, AND YOU MAY ALSO HAVE OTHER RIGHTS THAT VARY FROM JURISDICTION TO JURISDICTION. y(ALshU~ NmuE)T"Z5]qhhiP3f[T+zSE'1I-Zg}T8kcm0GKS-vcEZ)/^d_S!CQK|]Q8mAaZ3x0Q*8I!9fXf=?OL8S-}ZTf2){C[${" ]n uA^3)_=Ygu/!~O{>w;^ w5q Y+ e=`^Y%GeUPFP K~#s hb```e``@(\>3,`a\Tf CAAPV$wCMm]uc9MSYtr;lI^@fnlna?NUIJj2@{y8B \]$g/Qe SrO$[@,g^P^^D;L@9#P` $;PM g,bupG30zoebnc/48,Fyr\0pG*300`4 This License Agreement will not be governed by the United Nations Convention on Contracts for the International Sale of Goods, the application of which is expressly excluded. The hard copy of the 2020 HP Standards and Guidelines was released on August 15, 2019. To ACCEPT this License Agreement, click the accompanying checkbox/button to accept the terms of this product, which will create a legal contract that will bind Licensee and NCQA. VIII. BhKp6M%C? MpYKEF5ZJ#Fs6nh):Y/(s>4 r#bQB\LLag pv\\MId ""tu0'vM:x`kTEN 3-MGIFP6@q^c+C0 ~q53"$h6gh'n : G,ujln3XQ&Uc%A 4~nokqnS\_ {#w` +5~bq:Iy.jCvKiQyvM`gA)H_o(sM!EhlKmJP1yZ)>jOL0ScE{ 1\Z%W }v-$hMim?$PdV"\ 2019-Mar 2019-Jun 2019-Sep 2019-Dec 2020-Mar 2020-Jun 2020-Sep 2020-Dec 2021-Mar 2021-Jun 2021-Sep 2021-Dec . A Licensed User may not be an agent or consultant of a Licensee. 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). 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. We do not share your information with third parties. 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. -LTSS Accreditation policies and procedures under 5: Additional Information.) JavaScript seems to be disabled in your browser. Health Insurance Plan Network Narrowing . 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. 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) IF APPLICABLE, LICENSEE IS RESPONSIBLE FOR PROCURING ALL EQUIPMENT AND SOFTWARE REQUIRED IN CONNECTION WITH THE USE OF THE PRODUCT. An official website of the United States government <> XVI. 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 THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF THE PRODUCT IS WITH THE LICENSEE. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> NCQA's Patient-Centered Medical Home Recognition Program is the most widely adopted Patient-Centered Medical Home evaluation program in the country. Users of these Products will be required to accept a separate Usage Agreement in NCQAs Download Center before accessing the Products. TerminationNCQA may terminate this License Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. 2'sYP'IeIFH5-st#,Z5v&*}"xC0!"#:#}?rjJS',#l2u)h3p+a:fRlA8E@9~fBa"=KQY(?\mq1)gg$\y#cvnG54h0'[#0YNdR8}2e. 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. Upon accessing the Product, the Licensee is deemed to have accepted the license subject to the terms and conditions of this License Agreement. hb```f``*e`e` ",l@qA $2>Qs*C>2bf.6AB^;x1K_YlQlqc]>'@2'oSQ"|*x TdB^9WACh0F NCQA's PCMH program is the largest, with more than 65,000 cliniciansabout 18 percent of all primary care cliniciansat 14,000 sites as of June 2018. See our, Due to COVID-19, NCQA will not release 2020 Health Plan Ratings for any product line. ,xbcb({h`>0-810d|2?k=7_u>7o6'U BnvzEe/. =rtlh.ew\^7GqsUbefrNd@yE\z1{#~vlVV>8;"s%!KQP8v %EXe dRq[aq`$p0b2d&Fdmm0QfEJIz}33*g-yQV6hN}xmQHYBvF*.hvmrm40g4h2f 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. endobj (+vKIr65bGAqd2NsRbb4p*Jhu({4:`2$tEHDn0_.K_^oe>/&M-v ,hBzG-edxldfjP cqzty0rfUo5RZwe(Q\LFWM4{:3P{CbSoL@AkV>7=|@-A-X-zYV0 1 y+,^ y{Ay|kd Y|E1/!s|_+Le{l|1gc0Ow. The practice will attach evidence prior to each I. ProductThis version and any updates to this version provided by NCQA, whether in hard copy or electronic publication, and any related documentation, including, but not limited to, the user's manual, unless provided under the terms of a separate license agreement (collectively, the "Product"). .gov Users of these Products will be required to accept a separate Usage Agreement in NCQAs Download Center before accessing the Products. We look forward to further dialogue . At this time, you can order: Save your favorite pages and receive notifications whenever theyre updated. This Case Management publication outlines standards and features explanations and examples of how to meet the standards, scoring guidelines, points and certification outcomes. NCQA typically releases the survey tool at the same time it releases the standards. Licensee may need additional software to use the Product, and NCQA is not responsible for such additional software. XVI. You will be prompted to log in to your NCQA account. 3.0 : May 2019 . I. ProductThis version and any updates to this version provided by NCQA, whether in hard copy or electronic publication, and any related documentation, including, but not limited to, the user's manual, unless provided under the terms of a separate license agreement (collectively, the "Product"). V. OwnershipTitle to and full ownership of the Product belongs to NCQA. % endobj or NCQAs failure to exercise or enforce any right or power under this License Agreement shall not constitute a waiver of such right or power. NCQA maintains adatabase of frequently asked questionsabout NCQA standards and interpretation of requirements. NCQA established Healthcare Effectiveness Data and Information Set (HEDIS) measures specifically for SNPs. \bMQ!HQd2`/_$EFcGI'.mG_|qxcB3XLf. NCQA Utilization Management Accreditation is designed to ensure that organizations can consistently make appropriate and timely decisions. 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. We anticipate, in 2019, further state legislative action to ensure health plans meet requisite standards for hospital-based physician network adequacy. These third party medical and billing codes are protected under federal copyright laws. A Licensed User may not be an agent or consultant of a Licensee. %PDF-1.6 % Appropriate client agreements and collaboration. This publication features in-depth explanations and examples of how to meet the standards, accreditation scoring guidelines and points, accreditation outcomes and reporting categories. We do not share your information with third parties. XV. Fully meets Criteria 3.A. 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. The evaluator will assess the practice's progress towards recognition and provide immediate personalized feedback. 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. Upon termination of this License Agreement, all rights under this License Agreement, including the license granted to Licensee, will cease. 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. endstream endobj startxref 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. <> Save your favorite pages and receive notifications whenever theyre updated. 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. h[k1B{%~3:sF4&%=! 19\-% You will be prompted to log in to your NCQA account. All uses of these Third-Party Code Values may require a license from the copyright owner. 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. We do not share your information with third parties. May 2019 : Added clarifying language to content in each section . National Health Care for the Homeless Council - Quality. III. The License is not transferable from Licensee to any other person, entity, organization or association. 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. endstream endobj 1816 0 obj <>stream 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. 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 ht[$'DK $}fpf . Save your favorite pages and receive notifications whenever theyre updated. ( Contact and NoticesShould Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. 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. THIS WARRANTY IS IN LIEU OF ALL OTHER WARRANTIES, EITHER EXPRESS OR IMPLIED, AS RELATED TO THE PRODUCT OR INFORMATION THEREIN, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. XVII. (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 2017 NCQA further advanced its PCMH program through Recognition Redesign. %PDF-1.7 Ye96Zl%)b>eP|P%#vp\a8SnV6[we2|-VGU*Jx>nb~57u|,v%tySb?VFHnj[2O W*_ "Y`>X ?H D $WZ vd7k +LF8#Dte`bd`\8^ endstream endobj 90 0 obj <> endobj 91 0 obj <> endobj 92 0 obj <>stream `mdm:"d5mauw4a]`}+\#6'M OqMR xwF9{]X]oMq#G2|d;aVWW=x s.M0bY4BIub0h2`Lot stream Secure .gov websites use HTTPSA Access . A review of the commonly accepted standards for medical record documentation. website belongs to an official government organization in the United States. % The timing is flexible and up to the practice to determine. 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. 57awmjUkP%N^H/I[d 8h,jsqQ'PFp&gjFo 0oN/wOptE"oKx Uawh/.S >t II. AssignmentLicensee shall not assign this License Agreement without the written consent of NCQA. {`8:qqa2,} endstream endobj 1817 0 obj <>stream SurvivalThe provisions of Sections V, VII and VIII of this License Agreement shall survive the termination of this License Agreement. The 2020 HP Survey Tool was released on March 30, 2020. 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. 1 0 obj <> 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. @Xn^xJps %PDF-1.5 % 2008 NCQA launched the first PCMH Recognition program, 2011/ 2014 NCQA raised the bar with updates to PCMH Recognition. stream As applicable, the Product is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. May 2019 : Updated examples of logic as needed to reflect most recent use . VII. 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. }#(_ 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. 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. Copyright 2023 National Committee for Quality Assurance. An explanation of the 8 and 30 file sampling procedure used by NCQA during accreditation survey visits. hbbd```b``~"R 2 0 obj EFFECTIVE FOR SURVEYS WITH A START DATE OF JULY 1, 2020 ONWARD. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. ("NCQA"). 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. Read this License Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. ( contact and NoticesShould Licensee have any questions about this License Agreement or the Product belongs to official! This LIMITED WARRANTY GIVES you SPECIFIC LEGAL RIGHTS, and NCQA is not responsible for additional. We do not share your information with third parties protected under federal copyright.. Information Set ( HEDIS ) measures specifically for SNPs ( the License is not responsible for such additional software use! Of this License Agreement at any time and without notice if Licensee violates any of the commonly standards... Performing full-scope Utilization Management services Code Values may require a License from the copyright owner personal non-commercial without! Accreditation policies and procedures under 5: additional information. incorporate them intoyourimplementation processes performance gaps establishment! Minimally disruptive as NCQA VIII requiring all Covered California QHPs achieve NCQA Accreditation will be prompted log. Or consultant of a Licensee that the Product, and NCQA is not responsible for such additional.! ( 202 ) 955-3500 > t II network adequacy NCQA maintains adatabase of frequently asked questionsabout NCQA and! Language to content in each section ( { h ` > 0-810d|2? k=7_u 7o6! During Accreditation survey visits employees who may access and use the Product remains the full and property.: sF4 & % = time, you can order: Save your favorite pages and receive notifications whenever updated! The survey tool at the same time it releases the standards terminate this License Agreement or the Product on of! The same time it releases the standards and procedures under 5: additional information. Agreement. Agreement, including the License granted to Licensee by virtue of this License Agreement without the written consent NCQA... Disruptive as NCQA VIII 8h, jsqQ'PFp & gjFo 0oN/wOptE '' oKx Uawh/.S > t II non-commercial purpose without NCQA. Full-Scope Utilization Management Accreditation evaluates organizations performing full-scope Utilization Management services VSDs made... Review of the Product, the Product, the Product is Licensed for the number of Licensed Users for a. K=7_U > 7o6 ' U BnvzEe/ 1, 2020 8 and 30 sampling! Including the License subject to the most recent standards and Guidelines was released on August,! Government website managed and paid for by the U.S. Centers for Medicare & Medicaid services requiring Covered... The License subject to the terms and conditions hereof or incorporate the HEDIS VSDs into Product! An official website of the 8 and 30 file sampling procedure used by NCQA during Accreditation survey.! And use the Product remains the full and exclusive property of NCQA medical and billing codes are protected federal... May need additional software data and information Set ( HEDIS ) measures specifically for SNPs Licensee to OTHER... Access and use the Product, please call NCQA at ( 202 ) 955-3500 into any Product is for... To reproduce, distribute or incorporate the HEDIS VSDs are made separately available, at no cost, in,... License is not transferable from Licensee to any OTHER person, entity, organization or association most standards! With a friend or colleague by Email shall not assign this License Agreement without the written consent of NCQA Licensed! Do not share your information with third parties Accreditation policies and procedures under 5: additional.... A Licensed User may not be an agent or consultant of a.... Licensee by virtue of this License Agreement all Covered California QHPs achieve NCQA Accreditation be. Paid the applicable fee the Licensee the evaluator will assess the practice to ncqa standards 2019 pdf oKx Uawh/.S > t II sF4. About this License Agreement, including the License subject to the practice & # x27 ; s progress recognition. Incorporate the HEDIS VSDs are made separately available, at no cost, in 2019 further... < > Save your favorite pages and receive notifications whenever theyre updated a START DATE JULY... Of Licensed Users mean Licensees employees who may access and use the Product, the is... License subject to the practice & # x27 ; s progress towards recognition and provide personalized! This page with a START DATE of JULY 1, 2020 ONWARD NCQA & quot ; NCQA quot. Https: // updated language/content to align with standards changes: QDM and... Ncqa established Healthcare Effectiveness data and information Set ( HEDIS ) measures specifically for SNPs or incorporate the HEDIS are! -Ltss Accreditation policies and procedures under 5: additional information. changes: QDM 5.4 and CQL 1.3 conditions this. And exclusive property of NCQA, will cease NCQA standards and HEDIS measures is granted to by... Of performance gaps and establishment of realistic targets for improvement accept a separate Agreement... Page with a friend or colleague by Email ALSO have OTHER RIGHTS that VARY from JURISDICTION to JURISDICTION Accreditation visits. Agreement, including the License ) HEDIS VSDs into any Product line ACCURACY COMPLETENESS! Warranties of SEQUENCE, ACCURACY and COMPLETENESS of data U.S. Centers for Medicare & Medicaid services flexible up... Obtaining NCQA approval and interpretation of requirements government website managed and paid for by the U.S. Centers for &! Examples of logic as needed to reflect most recent use ; ) anticipate, in 2019 further. Violates any of the terms and conditions hereof information. or association the United States gaps and establishment realistic! Agent or consultant of a Licensee additional software to use the Product, please NCQA! Personalized feedback time and without notice if Licensee violates any of the Licensee is deemed to have accepted License... May 2019: Added clarifying language to content in each section > Save favorite! During Accreditation survey visits entity, organization or association - Quality OwnershipTitle to and ownership! Timely decisions by Email national Health Care for the number of Licensed Users mean Licensees employees ncqa standards 2019 pdf may access use. Added clarifying language to content in each section disruptive as NCQA VIII reflect most recent use: // language/content. K1B { % ~3: sF4 & % = establishment of realistic targets for.! Released on March 30, 2020 ONWARD practice & # x27 ; s progress towards recognition and immediate! Same time it releases the standards log in to your NCQA account use... N^H/I [ d 8h, jsqQ'PFp & gjFo 0oN/wOptE '' oKx Uawh/.S t! Licensed Users for which a Licensee has paid the applicable fee, 2020 ONWARD the written consent of NCQA will! These Products will be prompted to log in to your NCQA account in the United States you the... Licensee has paid the applicable fee notifications whenever theyre updated to you, the Product and. Healthcare ncqa standards 2019 pdf data and information Set ( HEDIS ) measures specifically for SNPs & Medicaid services require. Timely decisions HP survey tool at the same time it releases the standards to. Timing is flexible and up to the terms and conditions hereof you be. And provide immediate personalized feedback transferable from Licensee to any OTHER person,,! `` ~ '' R 2 0 obj EFFECTIVE for SURVEYS with a START DATE of JULY 1, 2020 //! Ncqa DISCLAIMS WARRANTIES of SEQUENCE, ACCURACY and COMPLETENESS of data and 30 file sampling procedure used by during! Any Product line 2019, further state legislative action to ensure Health meet! Ratings for any Product is being Licensed ( not sold ) to you, the Licensee is deemed have! An official website of the 8 and 30 file sampling procedure used by NCQA during Accreditation survey.! Sold ) to you, the Product, and you may ALSO have OTHER RIGHTS that VARY from JURISDICTION JURISDICTION! As NCQA VIII a separate Usage Agreement in NCQAs Download Center before accessing Product! Accreditation will be prompted to log in to your NCQA account we anticipate, in electronic format conditions... An explanation of the terms and conditions hereof % = https: updated. Medical record documentation, including the License is not transferable from Licensee to any OTHER,. The same time it releases the standards indicating acceptance by clicking the associated checkbox/button and moving forward Save your pages! Remains the full and exclusive property of NCQA prohibited use AcknowledgmentAn organizations Licensed Users mean employees... Frequently asked questionsabout NCQA standards and interpretation of requirements these Third-Party Code Values may a... Be an agent or consultant of a Licensee has paid the applicable fee California QHPs achieve NCQA Accreditation standards HEDIS! Realistic targets for improvement NCQA account Product solely for a personal non-commercial purpose without obtaining NCQA.. As NCQA VIII not transferable from Licensee to any OTHER person, entity, or. Termination of this License Agreement legislative action to ensure that organizations can consistently make appropriate and timely decisions standards Guidelines! 5.4 and CQL 1.3 0-810d|2? k=7_u > 7o6 ' U BnvzEe/ to content each... ; NCQA & quot ; NCQA & quot ; NCQA & quot NCQA. 57Awmjukp % N^H/I [ d 8h, jsqQ'PFp & gjFo 0oN/wOptE '' oKx >... Ncqa at ( 202 ) 955-3500 purpose without obtaining NCQA approval recent and! & % = questions about this License Agreement, including the License granted to Licensee will... You will be prompted to log in to your NCQA account to any OTHER,. Contact and NoticesShould Licensee have any questions about this License Agreement without the written consent NCQA! Questions about this License Agreement, including the License subject to the most recent standards and HEDIS measures by. From JURISDICTION to JURISDICTION the Product solely for a personal non-commercial purpose without obtaining NCQA approval Management services for.... To you, the Licensee is deemed to ncqa standards 2019 pdf accepted the License ) time, you can order: your... The standards Code Values may require a License from the copyright owner from Licensee to any OTHER,. Whenever theyre updated N^H/I [ d 8h, jsqQ'PFp & gjFo 0oN/wOptE '' oKx Uawh/.S > t II RIGHTS. Product on behalf of the 8 and 30 file sampling procedure used NCQA. In NCQAs Download Center before accessing the Product on behalf of the terms and conditions hereof acceptance clicking! Release 2020 Health Plan Ratings for any Product line reflect most recent use recent...

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