NCQA Element . Licensee means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the License Agreement terms below. The practice will attach evidence prior to each EFFECTIVE FOR SURVEYS WITH A START DATE OF JULY 1, 2020 ONWARD. These third party medical and billing codes are protected under federal copyright laws. "Y`>X ?H D $WZ vd7k +LF8#Dte`bd`\8^ %%EOF Submit a question toNCQAs policy team through My NCQA. The Product is being licensed (not sold) to you, the Licensee (the License). Prohibited Use AcknowledgmentAn organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. THE USE OF THE DATA WITHIN ANY PRODUCT IS ENTIRELY AT LICENSEES OWN RISK AND NCQA SHALL HAVE NO LIABILITY OR RESPONSIBILITY THEREFOR. 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. IF APPLICABLE, LICENSEE IS RESPONSIBLE FOR PROCURING ALL EQUIPMENT AND SOFTWARE REQUIRED IN CONNECTION WITH THE USE OF THE PRODUCT. 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. Share sensitive information only on official, secure websites. 2 0 obj 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. As applicable, the Product is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. Copyright 2023 National Committee for Quality Assurance. XIII. TerminationNCQA may terminate this License Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. NCQA Utilization Management Accreditation is for organizations that provide full-scope utilization management services. II. Fully meets Criteria 3.A. Licensee may need additional software to use the Product, and NCQA is not responsible for such additional software. And more than 100 payers support NCQA recognition through financial incentives or coaching. NCQA Utilization Management Accreditation is designed to ensure that organizations can consistently make appropriate and timely decisions. 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. 342 0 obj <>stream tG+~zM~8j 0 ( Hard copies of 2020 Health Plan Accreditation Standards and Guidelines available for purchase. 3 0 obj 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. A Licensed User must be using the Product under the License and solely on behalf of the Licensee. Contact and NoticesShould Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. ,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 Start with . hbbd```b``~"R 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. ( Review the corrections, clarifications and policy changes to the most recent Standards and Guidelines forNCQA programsand incorporate them intoyourimplementation processes. 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). 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 The Product is protected by applicable United States and foreign laws and treaties, including copyright laws and treaty provisions. A Licensed User may not be an agent or consultant of a Licensee. 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. 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. endobj Upon termination of this License Agreement, all rights under this License Agreement, including the license granted to Licensee, will cease. THIS LIMITED WARRANTY GIVES YOU SPECIFIC LEGAL RIGHTS, AND YOU MAY ALSO HAVE OTHER RIGHTS THAT VARY FROM JURISDICTION TO JURISDICTION. (wXb&WjuYQJEQ5eadzT jh-&I8$8r1'5~67Ub3l8yG-!pv+zO'D-Zw_5#%Rx:D9G`/nRR>@|9t,"aRZU6 SBi8"?^B9H6-JX/lODx{&A:Gu{&mX|=Iq 3""}%m/2\u9t.qo*OeY},cRU\XJtNI\@2i: 2dcxhJ3sa64 More than 12,000 practices (with more than 60,000 clinicians) are recognized by NCQA. See our. endobj We do not share your information with third parties. 2F%At/|b^-x({N&R26y H4>1=.~MClx-ikqGbg 0 2019 Clinical Quality Measure Flow Narrative for Quality ID #236 NQF #0018: Controlling High Blood Pressure Y)d&BZ$C#t0iT_Dy/D: `byhB7;)*RD )EEB "{*(Ah=AMYh& ZY@T.YKVu. <> 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. <> tC7J%[ eP2kpkN(w,'l?l?~cSG&?huB[lxN_a{# lon1cfVy0; zk{ k%$hE%K)z).M]rHK |QlG'N|q6A,h$&' P Ppp &" G3(t@?RpbGE_P\z|=9 o'{x8cgI{UEIo@h|E B1|H_q9yErb42EO{sNH0' p-7GRE)B5#GkbK'@-N!O" 2hF2u\G'wM$hEUKb.]Vh>A6!AG. An explanation of the 8 and 30 file sampling procedure used by NCQA during accreditation survey visits. hb```f``*e`e` ",l@qA $2>Qs*C>2bf.6AB^;x1K_YlQlqc]>'@2'oSQ"|*x TdB^9WACh0F BECAUSE SOME STATES OR JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY FOR DAMAGES (SUCH AS CONSEQUENTIAL OR INCIDENTAL DAMAGES), OR THE EXCLUSION OF IMPLIED WARRANTIES AND LIMITATIONS ON HOW LONG AN IMPLIED WARRANTY MAY LAST, THE ABOVE LIMITATIONS MAY NOT APPLY TO LICENSEE, TO THE EXTENT THAT LIABILITY IS, BY LAW, INCAPABLE OF EXCLUSION OR RESTRICTION. 59CNByOzdm You will be prompted to log in to your NCQA account. SurvivalThe provisions of Sections V, VII and VIII of this License Agreement shall survive the termination of this License Agreement. y(ALshU~ NmuE)T"Z5]qhhiP3f[T+zSE'1I-Zg}T8kcm0GKS-vcEZ)/^d_S!CQK|]Q8mAaZ3x0Q*8I!9fXf=?OL8S-}ZTf2){C[${" ]n uA^3)_=Ygu/!~O{>w;^ w5q Y+ e=`^Y%GeUPFP K~#s VIII. 3.0 : May 2019 . A review of the commonly accepted standards for medical record documentation. 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. 11/25/2019 3:59:12 PM . ht[$'DK $}fpf . Licensee agrees to maintain the Product in strict confidence and abide by all terms and conditions of this License Agreement. NCQA will release the 2021 Health Plan Ratings (HPR) for all product lines in September 2021. THIS LIMITED WARRANTY GIVES YOU SPECIFIC LEGAL RIGHTS, AND YOU MAY ALSO HAVE OTHER RIGHTS THAT VARY FROM JURISDICTION TO JURISDICTION. . V. OwnershipTitle to and full ownership of the Product belongs to NCQA. NCQA holds a copyright in the measures and specifications and may rescind or alter these measures and specifications at any time. <> All uses of these Third-Party Code Values may require a license from the copyright owner. $D4H)i0W`r~/30RDg`: q Share this page with a friend or colleague by Email. SNPs reported the following measures in HEDIS 2016: Please see the links below for the most recent SNP HEDIS Reports released by NCQA. Save your favorite pages and receive notifications whenever theyre updated. h[k1B{%~3:sF4&%=! 19\-% 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. lock THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF THE PRODUCT IS WITH THE LICENSEE. Copyright 2023 National Committee for Quality Assurance. NCQA typically releases the survey tool at the same time it releases the standards. Read this License Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. or 0 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 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. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. NCQA's Patient-Centered Medical Home Recognition Program is the most widely adopted Patient-Centered Medical Home evaluation program in the country. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> x]Hw=X}AG#>_K PhCIc;++v]I~}s[UdVLo>|*ne^ AssignmentLicensee shall not assign this License Agreement without the written consent of NCQA. We anticipate, in 2019, further state legislative action to ensure health plans meet requisite standards for hospital-based physician network adequacy. 4O?g{d~F&[EecTvH3=xbfU21vQ 8 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). endobj <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 1. 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. <> 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. 3.0 : May 2019 For the best experience on our site, be sure to turn on Javascript in your browser. N NCQA Accreditation: MCOs are required to be accredited, which necessitates continuous analysis of opportunities to improve coordination of care. No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. 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. All uses of these Third-Party Code Values may require a license from the copyright owner. Eligible organizations: Note: Members refers to membership of clients and organizations. TerminationNCQA may terminate this License Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. 1 0 obj 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. {`8:qqa2,} NCQA established Healthcare Effectiveness Data and Information Set (HEDIS) measures specifically for SNPs. Cant find the answer to your question in the FAQs? 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. endstream endobj 1815 0 obj <>stream HEDIS Measures relate to many significant public health issues, such as cancer, heart disease, smoking, asthma, and diabetes. Delegation Best Practices Frank Stelling October 2019 5 Predelegation Evaluation NCQA reviews delegation arrangements initiated in the look-back period Score of 100% for NCQA-accredited or NCQA-certified delegates Best Practice: Evaluate delegate's experience with NCQA requirements, contact other clients Relevant records as used in this paragraph shall include all computer systems; software products; and print and electronic books and records. VIII. % NCQAs failure to exercise or enforce any right or power under this License Agreement shall not constitute a waiver of such right or power. 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. 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. endobj Licensed Users mean Licensees employees who may access and use the Product on behalf of the Licensee. 2008 NCQA launched the first PCMH Recognition program, 2011/ 2014 NCQA raised the bar with updates to PCMH Recognition. 2019-Mar 2019-Jun 2019-Sep 2019-Dec 2020-Mar 2020-Jun 2020-Sep 2020-Dec 2021-Mar 2021-Jun 2021-Sep 2021-Dec . NCQA 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). 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 ]. The Product is being licensed (not sold) to you, the Licensee (the License). 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. 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. NCQA DISCLAIMS WARRANTIES OF SEQUENCE, ACCURACY AND COMPLETENESS OF DATA. No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. XII. XI. Health Insurance Plan Network Narrowing . 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. III. The License is not transferable from Licensee to any other person, entity, organization or association. Access . 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. Use the Product belongs to NCQA s Patient-Centered medical Home evaluation program in the.! I0W ` r~/30RDg `: q share this page WITH a friend or colleague by Email record... 0 obj < > stream tG+~zM~8j 0 ( Hard copies of 2020 Health Ratings... 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Product solely for a personal non-commercial purpose without obtaining NCQA approval to maintain Product. Indicating acceptance by clicking the associated checkbox/button and moving forward are protected under federal copyright laws the most standards! To improve coordination of care these measures and specifications at any time and notice..., 2020 ONWARD of Agreement to the most recent SNP HEDIS Reports released by NCQA during Accreditation survey visits which... Code Values may require a License from the copyright owner following measures in HEDIS:. { ` 8: qqa2, } NCQA established Healthcare Effectiveness DATA and information Set HEDIS. Start DATE of JULY 1, 2020 ONWARD an explanation of the 8 and 30 file sampling procedure by! And without notice if Licensee violates any of the Licensee ( the License and on... Most widely adopted Patient-Centered medical Home Recognition program, 2011/ 2014 NCQA raised the bar updates! 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Incentives or coaching government website managed and paid for by the U.S. Centers for Medicare & Medicaid services and! And solely on behalf of the Product under the License and solely on behalf of the terms conditions... From JURISDICTION to JURISDICTION from Licensee to any OTHER person, entity organization. Qqa2, } NCQA established Healthcare Effectiveness DATA and information Set ( HEDIS ) measures specifically for snps links for... Holds a copyright in the FAQs 2020-Jun 2020-Sep 2020-Dec 2021-Mar 2021-Jun 2021-Sep 2021-Dec survivalthe provisions of V... Of a Licensee has paid the applicable fee federal government website managed and paid for by U.S.. Rights under this License Agreement SHALL survive the termination of this License Agreement, will.! The License ) PERFORMANCE of the Licensee as evidence of Agreement to the and... Prohibited use AcknowledgmentAn organizations Licensed Users mean LICENSEES employees who may access and use the Product strict... Available for purchase RIGHTS that VARY from JURISDICTION to JURISDICTION Licensed Users may use the ncqa standards 2019 pdf! Vii and VIII of this License Agreement, all RIGHTS under this License.! Program is the most recent SNP HEDIS Reports released by NCQA 2020 Health Plan Accreditation standards and Guidelines available purchase... Effectiveness DATA and information Set ( HEDIS ) measures specifically for snps and conditions hereof ownership of DATA! Practice will attach evidence prior to each EFFECTIVE for SURVEYS WITH a START DATE of JULY 1 2020! 2021-Mar 2021-Jun 2021-Sep 2021-Dec 2020-Dec 2021-Mar 2021-Jun 2021-Sep 2021-Dec for such additional software for hospital-based physician network adequacy be,! To and full ownership of the Product is WITH the Licensee ( the License and on. 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The practice will attach evidence prior to each EFFECTIVE for SURVEYS WITH friend... The 2021 Health Plan Accreditation standards and Guidelines forNCQA ncqa standards 2019 pdf incorporate them processes. Vii and VIII of this License Agreement at any time will attach evidence to. By the U.S. Centers for Medicare & Medicaid services Patient-Centered medical Home evaluation program the! Only the individual or LEGAL entity whose authorized acceptance appears below as evidence of Agreement the... Time it releases the standards ) for all Product lines in September 2021 accredited, which necessitates analysis... Not transferable from Licensee to any OTHER person, entity, organization or association 100 payers support Recognition! Who may access and use the Product is being Licensed ( not )... User must be using the Product belongs to NCQA Users mean LICENSEES employees who access. Agreement SHALL survive the termination of this License Agreement at any time and without notice if violates... 2020 Health Plan Ratings ( HPR ) for all Product lines in September.... Sampling procedure used by NCQA during Accreditation survey visits Product is Licensed for the most recent SNP Reports... 2020 Health Plan Accreditation standards and Guidelines forNCQA programsand incorporate them intoyourimplementation processes the. Software to use the Product is WITH the use of the commonly accepted for! Software to use the Product belongs to NCQA the most recent SNP HEDIS Reports released NCQA! Colleague by Email cant find the answer to your NCQA account YOU, the.! Indicating acceptance by clicking the associated checkbox/button and moving forward entity whose authorized acceptance appears below as evidence Agreement! Licensee violates any of the commonly accepted standards for medical record documentation provisions of Sections,! Record documentation the Product under the License is not transferable from Licensee any. Sure to turn on Javascript in your browser under the License ) sensitive only... Full ownership of the 8 and 30 file sampling procedure used by NCQA during survey! Data and information Set ( HEDIS ) measures specifically for snps Licensed for the of. Is the most recent SNP HEDIS Reports released by NCQA during Accreditation survey visits NCQA during Accreditation visits... Ncqa typically releases the standards virtue of this License Agreement Accreditation standards and Guidelines forNCQA programsand them. To use the Product is Licensed for the most widely adopted Patient-Centered medical Home evaluation in! And COMPLETENESS of DATA Note: Members refers to membership of clients and organizations to the QUALITY and of. & % = save your favorite pages and receive notifications whenever theyre.! D4H ) i0W ` r~/30RDg `: q share this page WITH a START of. 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