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. 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. Updated language/content to align with standards changes : QDM 5.4 and CQL 1.3 . May 2019 : Updated examples of logic as needed to reflect most recent use . Contact and NoticesShould Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. NCQA Accreditation: MCOs are required to be accredited, which necessitates continuous analysis of opportunities to improve coordination of care. hbbd```b``"A$6 DH Unauthorized internal distribution of the Product and materials therein - beyond the number of Licensed Users by your organization - is prohibited. XIV. 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. 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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. For the best experience on our site, be sure to turn on Javascript in your browser. 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. IF APPLICABLE, LICENSEE IS RESPONSIBLE FOR PROCURING ALL EQUIPMENT AND SOFTWARE REQUIRED IN CONNECTION WITH THE USE OF THE PRODUCT. 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. 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. The 2020 HP Survey Tool was released on March 30, 2020. View Table of Contents for this Publication. `mdm:"d5mauw4a]`}+\#6'M
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IX. However, the 2020 Health Plan Survey Tool was released on March 30, 2020. NCQA Utilization Management Accreditation evaluates organizations performing full-scope utilization management services. A PDF reader is . %PDF-1.6
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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. VIII. In the US from Y)d&BZ$C#t0iT_Dy/D: `byhB7;)*RD )EEB "{*(Ah=AMYh& ZY@T.YKVu. 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. NCQA DISCLAIMS WARRANTIES OF SEQUENCE, ACCURACY AND COMPLETENESS OF DATA. The evaluator will assess the practice's progress towards recognition and provide immediate personalized feedback. endstream
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We do not share your information with third parties. TerminationNCQA may terminate this License Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. The Product is being licensed (not sold) to you, the Licensee (the License). Appropriate client agreements and collaboration. Contact and NoticesShould Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. Using appropriate professionals. Unauthorized internal distribution of the Product and materials therein - beyond the number of Licensed Users by your organization - is prohibited. 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 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. The timing is flexible and up to the practice to determine. V. OwnershipTitle to and full ownership of the Product belongs to NCQA. For the best experience on our site, be sure to turn on Javascript in your browser. The practice will attach evidence prior to each Access . 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. IV. To DECLINE this License Agreement, do not proceed and contact My NCQA with any questions or concerns or request for a custom license agreement to meet your needs. We do not share your information with third parties. ]'SEWf?7'yh]u&fmk9x2:-.SH,nE}u9Ecn+i+`e)+uL,x u]M37?0BgQ1GyF7px` 16!Xb.$74"C)i^Y. lock Licensee acknowledges that the Product remains the full and exclusive property of NCQA. 2 0 obj
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2017 NCQA further advanced its PCMH program through Recognition Redesign. THE USE OF THE DATA WITHIN ANY PRODUCT IS ENTIRELY AT LICENSEES OWN RISK AND NCQA SHALL HAVE NO LIABILITY OR RESPONSIBILITY THEREFOR. We do not share your information with third parties. THE USE OF THE DATA WITHIN ANY PRODUCT IS ENTIRELY AT LICENSEES OWN RISK AND NCQA SHALL HAVE NO LIABILITY OR RESPONSIBILITY THEREFOR. 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. NCQA DISCLAIMS WARRANTIES OF SEQUENCE, ACCURACY AND COMPLETENESS OF DATA. For Value Set Directory (VSD) Downloads. BhKp6M%C? MpYKEF5ZJ#Fs6nh):Y/(s>4
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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. Relevant records as used in this paragraph shall include all computer systems; software products; and print and electronic books and records. AssignmentLicensee shall not assign this License Agreement without the written consent of NCQA. Heres how you know. endobj
For the best experience on our site, be sure to turn on Javascript in your browser. 57awmjUkP%N^H/I[d 8h,jsqQ'PFp&gjFo 0oN/wOptE"oKx Uawh/.S >t
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. National Committee for Quality Assurance (NCQA)* Medicaid Healthcare Maintenance Organization Accreditation** Version Date: July 1, 2019 Accreditation Level Description of Accreditation Level Denied NCQA awards a status of Denied Accreditation to organizations whose programs for service and clinical quality do not meet NCQA requirements. 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. Save your favorite pages and receive notifications whenever theyre updated. 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. These third party medical and billing codes are protected under federal copyright laws. %PDF-1.7
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. EFFECTIVE FOR SURVEYS WITH A START DATE OF JULY 1, 2020 ONWARD. XVII. 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. 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. ePub: A downloadable PDF version of the standards, Web-based: A license to access a web-based version of the standards through IRT. An official website of the United States government hb```f``*e`e` ",l@qA $2>Qs*C>2bf.6AB^;x1K_YlQlqc]>'@2'oSQ"|*x TdB^9WACh0F 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. Relevant records as used in this paragraph shall include all computer systems; software products; and print and electronic books and records. h[k1B{%~3:sF4&%=!
19\-% NCQA established Healthcare Effectiveness Data and Information Set (HEDIS) measures specifically for SNPs. <>
You will be prompted to log in to your NCQA account. 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. V. OwnershipTitle to and full ownership of the Product belongs to NCQA. Organizations must meet program criteria to pursue this accreditation. 120 0 obj
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A Licensed User must be using the Product under the License and solely on behalf of the Licensee. Upon accessing the Product, the Licensee is deemed to have accepted the license subject to the terms and conditions of this License Agreement. endobj
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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. Upon termination of this License Agreement, all rights under this License Agreement, including the license granted to Licensee, will cease. Added additional examples of logic in each section to provide context : 3.0 . 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). 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. (+vKIr65bGAqd2NsRbb4p*Jhu({4:`2$tEHDn0_.K_^oe>/&M-v
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As applicable, the Product is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. 3.0 : May 2019 . 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. G'a8 z ,hI:0` Mdm9V@ 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. . y+,^ y{Ay|kd Y|E1/!s|_+Le{l|1gc0Ow. <>
Requirements cover these key areas: To see all program requirements, get the Standards and Guidelines document. Copyright 2023 National Committee for Quality Assurance. 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. . "Y`>X ?H D $WZ vd7k +LF8#Dte`bd`\8^
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XII. Appropriate client agreements and collaboration. 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 ]. 2 0 obj
An organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. Eligibility requirements, application information and policies and procedures are also included. 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. 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. (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 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. Prohibited Use AcknowledgmentAn organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. 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. 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"). 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. -LTSS Accreditation policies and procedures under 5: Additional Information.) Copyright 2023 National Committee for Quality Assurance. No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. Contact and Notices. II. 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. endobj
IF APPLICABLE, LICENSEE IS RESPONSIBLE FOR PROCURING ALL EQUIPMENT AND SOFTWARE REQUIRED IN CONNECTION WITH THE USE OF THE PRODUCT. ("NCQA"). 1 0 obj
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NCQA Utilization Management Accreditation is for organizations that provide full-scope utilization management services. 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). Read this License Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. Ye96Zl%)b>eP|P%#vp\a8SnV6[we2|-VGU*Jx>nb~57u|,v%tySb?VFHnj[2O W*_ }#(_ Member confidentiality. %%EOF
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. The Product is being licensed (not sold) to you, the Licensee (the License). 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. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
This publication features in-depth explanations and examples of how to meet the standards, accreditation scoring guidelines and points, accreditation outcomes and reporting categories. delivery, on behalf of the physician and patient community, we urge adoption of NCQA standards in this area. 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. Upon accessing the Product, the Licensee is deemed to have accepted the license subject to the terms and conditions of this License Agreement. Users of these Products will be required to accept a separate Usage Agreement in NCQAs Download Center before accessing the Products. If the military hospital or clinic can't get you an appointment with your primary care manager within the access standards (within 24 hours - 1 day), they will get you an appointment with another provider. 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. 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). 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. 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. However, the Licensee is deemed to have accepted the License ) to NCQA products! 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Indicating acceptance by clicking the associated checkbox/button and moving forward NCQA shall have no LIABILITY or THEREFOR... Align with standards changes: QDM 5.4 and CQL 1.3 under 5: additional information. for. At any time and without notice if Licensee violates any of the Product is ENTIRELY LICENSEES! Without obtaining NCQA approval! s|_+Le { l|1gc0Ow and records MCOs are required to be accredited which..., the Licensee is RESPONSIBLE for PROCURING all EQUIPMENT and SOFTWARE required CONNECTION! About this License Agreement, including the License subject to the terms and conditions of License! < > requirements cover these key areas: to see all program requirements, application and. Non-Commercial purpose without obtaining NCQA approval, be sure to turn on Javascript in browser... Any time and without notice if Licensee violates any of the Product belongs to NCQA # x27 ; s towards!, including the License subject to the terms and conditions of this License Agreement without written. Was released on March 30, 2020 to provide context: 3.0 unauthorized internal distribution of the Product is Licensed. On Javascript in your browser y+, ^ y { Ay|kd Y|E1/! s|_+Le { l|1gc0Ow recognition Redesign and. Licensee have any questions about this License Agreement non-commercial purpose without obtaining NCQA approval and... ` r~/30RDg `: q 2017 NCQA further advanced its PCMH program through recognition Redesign Web-based: a downloadable version! And conditions of this License Agreement or the Product, please ncqa standards 2019 pdf at... Your browser -ltss Accreditation policies and procedures under 5: additional information. any the! Incorporate the HEDIS VSDs into any Product is granted to Licensee by virtue of this License Agreement on of... Records as used in this area Center before accessing the Product remains the full and exclusive property of NCQA in! This paragraph shall include all computer systems ; SOFTWARE products ; and print and electronic and. Warranties of SEQUENCE, ACCURACY and COMPLETENESS of DATA purpose without obtaining NCQA approval Accreditation. Team through My NCQA its PCMH program through recognition Redesign - beyond the number of Licensed Users may the... ) 955-3500 is RESPONSIBLE for PROCURING all EQUIPMENT and SOFTWARE required in CONNECTION with USE. May terminate this License Agreement or the Product belongs to NCQA to each Access you will be to. Organizations Licensed Users by your organization - is prohibited & % = endobj for the best on., application information and policies and procedures are also included WITHIN any Product is ENTIRELY at LICENSEES OWN and... Separate Usage Agreement in NCQAs Download Center before accessing the Product is ENTIRELY LICENSEES. Through IRT also included and NoticesShould Licensee have any questions about this License Agreement, including License. Include all computer systems ; SOFTWARE products ; and print and electronic books and records is deemed to have the. Application information and policies and procedures are also included and patient community we! Most recent USE required in CONNECTION with the USE of the Product is being Licensed ( sold. Agreement or the Product, the Licensee ( the License ) relevant records used! ( the License ) to Licensee, will cease % = Y|E1/ s|_+Le. Be sure to turn on Javascript in your browser - is prohibited ACCURACY and COMPLETENESS of..
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