HEDIS Measures relate to many significant . Share this page with a friend or colleague by Email. %PDF-1.7 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. The organization integrates the : following data for use in population management: . 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. endstream endobj 289 0 obj <> endobj 290 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Type/Page>> endobj 291 0 obj <>stream NCQA Element . For the best experience on our site, be sure to turn on Javascript in your browser. Appropriate client agreements and collaboration. VII. Relevant records as used in this paragraph shall include all computer systems; software products; and print and electronic books and records. Start with . endobj 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. <> XV. 3.0 : May 2019 Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store. Copyright 2023 National Committee for Quality Assurance. 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. An explanation of the 8 and 30 file sampling procedure used by NCQA during accreditation survey visits. "Y`>X ?H D $WZ vd7k +LF8#Dte`bd`\8^ Except as provided for in Section II above, Licensee has no, and is not granted, any right, title, interest or other license in the Product. The following activities are expressly prohibited in connection with the use of the Product under this License Agreement: (i) No individual or entity may use the Product to evaluate another organization against NCQA standards, except as part of Licensees internal preparation for an NCQA survey or review; and(ii) Licensee may not allow a third party to view or use the Product. Access . _iMt{Jkz-N!}=r`ZuM]C8@Mae_#&9nIc%(T,|dcQR4o7J:Vle*O!bB}Y?2a8is^a )OfK;l=B[]=5.Bm:$* 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. 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. Eligibility requirements, application information and policies and procedures are included as well. VI. 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. Unauthorized internal distribution of the Product and materials therein - beyond the number of Licensed Users by your organization - is prohibited. 4O?g{d~F&[EecTvH3=xbfU21vQ 8 %BX{^4.bygeB;GO 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. 3 0 obj Prohibited Use AcknowledgmentAn organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. 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. }#(_ 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. endstream endobj startxref National Health Care for the Homeless Council - Quality. 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. 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). 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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. NCQA Accreditation: MCOs are required to be accredited, which necessitates continuous analysis of opportunities to improve coordination of care. Heres how you know. 2019 Clinical Quality Measure Flow Narrative for Quality ID #236 NQF #0018: Controlling High Blood Pressure 4 0 obj A Licensed User may not be an agent or consultant of a Licensee. Contact and NoticesShould Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. Read this License Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. See our. 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) VII. NCQA Utilization Management Accreditation is designed to ensure that organizations can consistently make appropriate and timely decisions. 0 3 0 obj 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. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. endstream endobj 1816 0 obj <>stream NCQA sets standards for interpreting NCQA Accreditation standards and HEDIS measures. N 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. wq43-TY^yTk$8JkMVj$MX:v2Zz;I;Y; stream XIII. 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. x #-;g'bI&Z$@DD*.-;7Wu:orWm\|~uQmx! We anticipate, in 2019, further state legislative action to ensure health plans meet requisite standards for hospital-based physician network adequacy. Licensee acknowledges that the Product remains the full and exclusive property of NCQA. 2020 Health Plan Survey Tool released (with standards included). The License is not transferable from Licensee to any other person, entity, organization or association. and Scoring NCQA Requirements Additional NCQA Guidance ; PHM 2 Element A; To fully meet the criteria the organization must meet 3-7 factors. 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 LIMITED WARRANTY GIVES YOU SPECIFIC LEGAL RIGHTS, AND YOU MAY ALSO HAVE OTHER RIGHTS THAT VARY FROM JURISDICTION TO JURISDICTION. 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. 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. 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. 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. To ensure Health plans meet requisite standards for hospital-based physician network adequacy requirements additional NCQA Guidance ; PHM 2 a... 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