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. 2019-Mar 2019-Jun 2019-Sep 2019-Dec 2020-Mar 2020-Jun 2020-Sep 2020-Dec 2021-Mar 2021-Jun 2021-Sep 2021-Dec . Licensee means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the License Agreement terms below. 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. 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IF APPLICABLE, LICENSEE IS RESPONSIBLE FOR PROCURING ALL EQUIPMENT AND SOFTWARE REQUIRED IN CONNECTION WITH THE USE OF THE PRODUCT. For the best experience on our site, be sure to turn on Javascript in your browser. 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. Hard copies of 2020 Health Plan Accreditation Standards and Guidelines available for purchase. 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. %%EOF A Licensed User must be using the Product under the License and solely on behalf of the Licensee. Eligibility requirements, application information and policies and procedures are also included. Share sensitive information only on official, secure websites. 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. Save your favorite pages and receive notifications whenever theyre updated. JavaScript seems to be disabled in your browser. 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 ]. <>/Metadata 330 0 R/ViewerPreferences 331 0 R>> SurvivalThe provisions of Sections V, VII and VIII of this License Agreement shall survive the termination of this License Agreement. 2 0 obj These third party medical and billing codes are protected under federal copyright laws. 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. Added additional examples of logic in each section to provide context : 3.0 . 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. Copyright 2023 National Committee for Quality Assurance. Unauthorized internal distribution of the Product and materials therein - beyond the number of Licensed Users by your organization - is prohibited. XVII. The 2020 HP Survey Tool was released on March 30, 2020. 0 No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. Upon termination of this License Agreement, all rights under this License Agreement, including the license granted to Licensee, will cease. 3 0 obj Upon termination of this License Agreement, all rights under this License Agreement, including the license granted to Licensee, will cease. View Table of Contents for this Publication. 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. 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"). 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. An organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. May 2019 : Updated examples of logic as needed to reflect most recent use . XVII. [UuKo-3q/pEqx".z+EX,?+"'MNb)=)V+QK,gK!^}@]^,\J N8AB[0|7x MbN_M9[1g05KL :7f>~C|Vp$'*.ljYZ\l:ZS|s{No#mi',tg,j>0~Y=%B-}xi(~ hA_wfsb { You will be prompted to log in to your NCQA account. _iMt{Jkz-N!}=r`ZuM]C8@Mae_#&9nIc%(T,|dcQR4o7J:Vle*O!bB}Y?2a8is^a )OfK;l=B[]=5.Bm:$* 0 %PDF-1.7 (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 Licensee acknowledges that the Product remains the full and exclusive property 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. 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. TerminationNCQA may terminate this License Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. Should Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. 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. Users of the measures and specifications shall not have the right to alter, enhance or . The 2020 Health Plan Accreditation Standards and Guidelines were released on July 29, 2019. EFFECTIVE FOR SURVEYS WITH A START DATE OF JULY 1, 2020 ONWARD. The License is not transferable from Licensee to any other person, entity, organization or association. NCQA established Healthcare Effectiveness Data and Information Set (HEDIS) measures specifically for SNPs. 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. 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. wq43-TY^yTk$8JkMVj$MX:v2Zz;I;Y; <> Licensed Users mean Licensees employees who may access and use the Product on behalf of the Licensee. 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. hb```f``*e`e` ",l@qA $2>Qs*C>2bf.6AB^;x1K_YlQlqc]>'@2'oSQ"|*x TdB^9WACh0F VIII. We anticipate, in 2019, further state legislative action to ensure health plans meet requisite standards for hospital-based physician network adequacy. NCQA will release the 2021 Health Plan Ratings (HPR) for all product lines in September 2021. JavaScript seems to be disabled in your browser. endobj NCQA or its licensors own all rights, title and interests in the Product, including trade secrets, patents, copyrights and database rights, and the Product shall remain the sole and exclusive property of NCQA (except as otherwise set forth below regarding third party copyright ownership of portions of HEDIS VSDs). . 2F%At/|b^-x({N&R26y H4>1=.~MClx-ikqGbg This publication features in-depth explanations and examples of how to meet the standards, accreditation scoring guidelines and points, accreditation outcomes and reporting categories. Share this page with a friend or colleague by Email. N This License Agreement will not be governed by the United Nations Convention on Contracts for the International Sale of Goods, the application of which is expressly excluded. V. OwnershipTitle to and full ownership of the Product belongs to NCQA. Licensee means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the License Agreement terms below. Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store. h\AN@E27dRTQbQB*=vX{r$e K8Z+*;e_?St*[|e[o-;/6MpnC\Hdy rL|LIr2e_D,F1+^1W+s N$oK)R493{py #xtV>zxk13No9:C_ eH__C/WpGOav4 The License is not transferable from Licensee to any other person, entity, organization or association. endobj 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. NCQA Utilization Management Accreditation is for organizations that provide full-scope utilization management services. 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. The practice will attach evidence prior to each y.b.S3TKZ`nQ\Y=!|%l6dE0^x&x]|JWbrK.6St>6?/t no_W>^1%M],C~eWgC}hSdd JfSQDAG. Upon accessing the Product, the Licensee is deemed to have accepted the license subject to the terms and conditions of this License Agreement. 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. NCQA Utilization Management Accreditation is designed to ensure that organizations can consistently make appropriate and timely decisions. VI. 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. 342 0 obj <>stream %BX{^4.bygeB;GO 2019 Clinical Quality Measure Flow Narrative for Quality ID #236 NQF #0018: Controlling High Blood Pressure }#(_ Eligible organizations: Note: Members refers to membership of clients and organizations. THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF THE PRODUCT IS WITH THE LICENSEE. 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. 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"). Share this page with a friend or colleague by Email. VI. XVI. 2008 NCQA launched the first PCMH Recognition program, 2011/ 2014 NCQA raised the bar with updates to PCMH Recognition. 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 sets standards for interpreting NCQA Accreditation standards and HEDIS measures. 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