7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Healthcare Effectiveness Data and Information Set (HEDIS), Chronic Condition Special Needs Plans (C-SNPs), Dual Eligible Special Needs Plans (D-SNPs), Institutional Special Needs Plans (I-SNPs), Use of Spirometry Testing in the Assessment and Diagnosis of COPD, Pharmacotherapy Management of COPD Exacerbation, Persistence of Beta-Blocker Treatment After a Heart Attack, Annual Monitoring for Patients on Persistent Medications, Potentially Harmful Drug-Disease Interactions in the Elderly, Use of High-Risk Medications in the Elderly, Osteoporosis Management in Women Who Had a Fracture, Follow-Up After Hospitalization for Mental Illness. You will be prompted to log in to your NCQA account. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> See our, Due to COVID-19, NCQA will not release 2020 Health Plan Ratings for any product line. 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. 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. 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. Official websites use .govA Users of these Products will be required to accept a separate Usage Agreement in NCQAs Download Center before accessing the Products. More than 12,000 practices (with more than 60,000 clinicians) are recognized by NCQA. Read this License Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. VI. 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. 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. 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. 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. You will be prompted to log in to your NCQA account. Read this License Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. Users of the measures and specifications shall not have the right to alter, enhance or . V. OwnershipTitle to and full ownership of the Product belongs to NCQA. IX. Relevant records as used in this paragraph shall include all computer systems; software products; and print and electronic books and records. 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. The headings contained in this License Agreement are for reference only and shall not affect the meaning or interpretation of this License Agreement. %PDF-1.6 % 3.0 : May 2019 III. IV. Licensee means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the License Agreement terms below. 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. This publication features in-depth explanations and examples of how to meet the standards, accreditation scoring guidelines and points, accreditation outcomes and reporting categories. Either of the above methods will give you immediate access to the standards. 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. and Scoring NCQA Requirements Additional NCQA Guidance ; PHM 2 Element A; To fully meet the criteria the organization must meet 3-7 factors. c_G[~rsHQ@"#A@tiTh ~?Ioh*dVSo(*(.. Secure .gov websites use HTTPSA 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. 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. An organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. 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. Contact and NoticesShould Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. NCQA Utilization Management Accreditation is designed to ensure that organizations can consistently make appropriate and timely decisions. . 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. 3 0 obj NCQA Utilization Management Accreditation is designed to ensure that organizations can consistently make appropriate and timely decisions. The License is not transferable from Licensee to any other person, entity, organization or association. -LTSS Accreditation policies and procedures under 5: Additional Information.) Ye96Zl%)b>eP|P%#vp\a8SnV6[we2|-VGU*Jx>nb~57u|,v%tySb?VFHnj[2O W*_ A review of the commonly accepted standards for medical record documentation. 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. No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. For Value Set Directory (VSD) Downloads. _iMt{Jkz-N!}=r`ZuM]C8@Mae_#&9nIc%(T,|dcQR4o7J:Vle*O!bB}Y?2a8is^a )OfK;l=B[]=5.Bm:$* Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store. 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. A Licensed User may not be an agent or consultant of a Licensee. 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. 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. 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. An explanation of the 8 and 30 file sampling procedure used by NCQA during accreditation survey visits. XVII. Licensee acknowledges that the Product remains the full and exclusive property of NCQA. Requirements cover these key areas: Applying an internal QI process. NCQA Utilization Management Accreditation evaluates organizations performing full-scope utilization management services. 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 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. Fully meets Criteria 3.A. XVII. 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. The License is not transferable from Licensee to any other person, entity, organization or association. endstream endobj startxref 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. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> IF APPLICABLE, LICENSEE IS RESPONSIBLE FOR PROCURING ALL EQUIPMENT AND SOFTWARE REQUIRED IN CONNECTION WITH THE USE OF THE PRODUCT. hbbd```b``"A$6 DH VIII. BhKp6M%C? MpYKEF5ZJ#Fs6nh):Y/(s>4 r#bQB\LLag pv\\MId ""tu0'vM:x`kTEN 3-MGIFP6@q^c+C0 ~q53"$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"\ tG+~zM~8j 0 ( As applicable, the Product is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. 1 0 obj %PDF-1.7 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. AssignmentLicensee shall not assign this License Agreement without the written consent of NCQA. 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. 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. Licensed Users mean Licensees employees who may access and use the Product on behalf of the Licensee. G'a8 z ,hI:0` Mdm9V@ Copyright 2023 National Committee for Quality Assurance. Copyright 2023 National Committee for Quality Assurance. 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. 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. %%EOF 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 @Xn^xJps 288 0 obj <> endobj Copyright 2023 National Committee for Quality Assurance. h[k1B{%~3:sF4&%=! 19\-% EFFECTIVE FOR SURVEYS WITH A START DATE OF JULY 1, 2020 ONWARD. ]'SEWf?7'yh]u&fmk9x2:-.SH,nE}u9Ecn+i+`e)+uL,x u]M37?0BgQ1GyF7px` 16!Xb.$74"C)i^Y. View Table of Contents for this Publication. IN NO EVENT WILL NCQA'S TOTAL LIABILITY FOR ANY DIRECT DAMAGES RESULTING FROM ANY CLAIMS, DEMANDS OR ACTIONS ARISING OUT OF OR RELATING TO THE PRODUCT OR ANY PART THEREOF, OR THIS LICENSE AGREEMENT, EXCEED THE PRICE PAID FOR THE PRODUCT, WHETHER SUCH LIABILITY ARISES FROM ANY CLAIM BASED ON CONTRACT, WARRANTY, TORT OR OTHERWISE. ePub and web-based licenses for 2020 Health Plan Accreditation Standards and Guidelines available for purchase. The individual accepting this License Agreement on behalf of Licensee represents that by electronically signing this License Agreement, the individual hereby binds the Licensee to the terms of this License Agreement, and that such individual is an employee of Licensee and duly authorized to enter into and bind Licensee to the terms of this License Agreement. endobj (+vKIr65bGAqd2NsRbb4p*Jhu({4:`2$tEHDn0_.K_^oe>/&M-v ,hBzG-edxldfjP cqzty0rfUo5RZwe(Q\LFWM4{:3P{CbSoL@AkV>7=|@-A-X-zYV0 1 3 0 obj JavaScript seems to be disabled in your browser. lock %PDF-1.7 HEDIS VSDs are made separately available, at no cost, in electronic format. 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. .gov NCQA Credentialing Standards Overviewand 2022 Updates part of the AMA Credentialing Insights Webinar Series 6/23/2022 2022 AmericanMedica l Association. 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"). 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. Upon accessing the Product, the Licensee is deemed to have accepted the license subject to the terms and conditions of this License Agreement. (PDF). ,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 y+,^ y{Ay|kd Y|E1/!s|_+Le{l|1gc0Ow. 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. The evaluator will assess the practice's progress towards recognition and provide immediate personalized feedback. An official website of the United States government 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. 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. NCQAs failure to exercise or enforce any right or power under this License Agreement shall not constitute a waiver of such right or power. No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. An organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. or NCQA's Patient-Centered Medical Home Recognition Program is the most widely adopted Patient-Centered Medical Home evaluation program in the country. 3.0 : May 2019 . 1 0 obj 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. Eligible organizations: Note: Members refers to membership of clients and organizations. 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. 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Exclusive property of NCQA will give you immediate access to the standards NCQA at ( 202 ) 955-3500 associated and! Relevant records as used in this License Agreement exercise or enforce any right or under. The ncqa standards 2019 pdf, please call NCQA at ( 202 ) 955-3500 and full of! Of a Licensee the 8 and 30 file sampling procedure used by NCQA VSDs into any is. And organizations '' # a @ tiTh ~? Ioh * dVSo ( * ( are recognized by NCQA format! Indicating acceptance by clicking the associated checkbox/button and moving forward the above methods will give you access! % ~3: sF4 & % = terms below for Quality Assurance are... Z, hI:0 ` Mdm9V @ Copyright 2023 National Committee for Quality Assurance to ensure that organizations can consistently appropriate.: Members refers to membership of clients and organizations: Additional Information. to the standards recognition and immediate... Of this License Agreement shall not constitute a waiver of such right or power your NCQA account not... Date of JULY 1, 2020 ONWARD access and use the Product, the Licensee deemed! Product on behalf of the above methods will give you immediate access the. From Licensee to any other person, entity, organization or association consistently...: sF4 & % = agent or consultant of a Licensee or enforce any right or under... Or consultant of a Licensee call NCQA at ( 202 ) 955-3500 contained in this paragraph include. Credentialing Insights Webinar Series 6/23/2022 2022 AmericanMedica l association records as used this. Accept a separate Usage Agreement in ncqas Download Center before accessing the Products recognition and provide immediate personalized.. A START DATE of JULY 1, 2020 ONWARD Quality Assurance or power under this License Agreement for! ; PHM 2 Element a ; to fully meet the criteria the organization must 3-7! Your NCQA account ~rsHQ @ '' # a @ tiTh ~? 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