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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. VI. hb```f``*e`e` ",l@qA $2>Qs*C>2bf.6AB^;x1K_YlQlqc]>'@2'oSQ"|*x TdB^9WACh0F Any use of the Product to identify records or calculate HEDIS measure results, for example, requires a custom license and may necessitate certification pursuant to NCQAs Measure Certification Program. website belongs to an official government organization in the United States. 133 0 obj <>stream However, the 2020 Health Plan Survey Tool was released on March 30, 2020. Hard copies of 2020 Health Plan Accreditation Standards and Guidelines available for purchase. All uses of these Third-Party Code Values may require a license from the copyright owner. Focus areas to ensure high quality. NCQAs failure to exercise or enforce any right or power under this License Agreement shall not constitute a waiver of such right or power. 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. . Licensed Users mean Licensees employees who may access and use the Product on behalf of the Licensee. 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 NCQA will release the 2021 Health Plan Ratings (HPR) for all product lines in September 2021. XI. 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. 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. Added additional examples of logic in each section to provide context : 3.0 . 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. 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) In the US from ) Start with . SNPs reported the following measures in HEDIS 2016: Please see the links below for the most recent SNP HEDIS Reports released by NCQA. endobj V. OwnershipTitle to and full ownership of the Product belongs to 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). Unauthorized internal distribution of the Product and materials therein - beyond the number of Licensed Users by your organization - is prohibited. Fully meets Criteria 3.A. 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. THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF THE PRODUCT IS WITH THE LICENSEE. 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 The 2020 Health Plan Accreditation Standards and Guidelines were released on July 29, 2019. Member confidentiality. 2'sYP'IeIFH5-st#,Z5v&*}"xC0!"#:#}?rjJS',#l2u)h3p+a:fRlA8E@9~fBa"=KQY(?\mq1)gg$\y#cvnG54h0'[#0YNdR8}2e. hb```e``@(\>3,`a\Tf CAAPV$wCMm]uc9MSYtr;lI^@fnlna?NUIJj2@{y8B \]$g/Qe SrO$[@,g^P^^D;L@9#P` $;PM g,bupG30zoebnc/48,Fyr\0pG*300`4 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. %PDF-1.7 2019-Mar 2019-Jun 2019-Sep 2019-Dec 2020-Mar 2020-Jun 2020-Sep 2020-Dec 2021-Mar 2021-Jun 2021-Sep 2021-Dec . 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. V. OwnershipTitle to and full ownership of the Product belongs to NCQA. NCQA Utilization Management Accreditation is designed to ensure that organizations can consistently make appropriate and timely decisions. THIS LIMITED WARRANTY GIVES YOU SPECIFIC LEGAL RIGHTS, AND YOU MAY ALSO HAVE OTHER RIGHTS THAT VARY FROM JURISDICTION TO JURISDICTION. 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. The 2020 Health Plan Accreditation Standards and Guidelines were released on July 29, 2019. <>/Metadata 1649 0 R/ViewerPreferences 1650 0 R>> VIII. %PDF-1.6 % 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. Read this License Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. 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. A$"0< -@ cfa+`}0@9w.IGX'b;|OI 1 0 obj 2F%At/|b^-x({N&R26y H4>1=.~MClx-ikqGbg An official website of the United States government 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. 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. A Licensed User must be using the Product under the License and solely on behalf of the Licensee. You will be prompted to log in to your NCQA account. VII. Eligibility requirements, application information and policies and procedures are included as well. 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. 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. IV. Should Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. x]Hw=X}AG#>_K PhCIc;++v]I~}s[UdVLo>|*ne^ 59CNByOzdm The headings contained in this License Agreement are for reference only and shall not affect the meaning or interpretation of this License Agreement. 2 0 obj Appropriate client agreements and collaboration. ,xbcb({h`>0-810d|2?k=7_u>7o6'U BnvzEe/. =rtlh.ew\^7GqsUbefrNd@yE\z1{#~vlVV>8;"s%!KQP8v %EXe dRq[aq`$p0b2d&Fdmm0QfEJIz}33*g-yQV6hN}xmQHYBvF*.hvmrm40g4h2f Y)d&BZ$C#t0iT_Dy/D: `byhB7;)*RD )EEB "{*(Ah=AMYh& ZY@T.YKVu. Appropriate client agreements and collaboration. We do not share your information with third parties. %PDF-1.7 "Y`>X ?H D $WZ vd7k +LF8#Dte`bd`\8^ Either of the above methods will give you immediate access to the standards. 2019 Clinical Quality Measure Flow Narrative for Quality ID #236 NQF #0018: Controlling High Blood Pressure 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 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. III. 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. 2017 NCQA further advanced its PCMH program through Recognition Redesign. 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. VIII. N A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. tc;m1aIb We look forward to further dialogue . 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. At this time, you can order: Save your favorite pages and receive notifications whenever theyre updated. 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. XVI. Requirements cover these key areas: Applying an internal QI process. 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. 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. 0 $D4H)i0W`r~/30RDg`: q Relevant records as used in this paragraph shall include all computer systems; software products; and print and electronic books and records. As applicable, the Product is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. Updated language/content to align with standards changes : QDM 5.4 and CQL 1.3 . View Table of Contents for this Publication. 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. 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. XVII. VI. Contact and Notices. Requirements cover these key areas: To see all program requirements, get the Standards and Guidelines document. XIII. Cant find the answer to your question in the FAQs? TerminationNCQA may terminate this License Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. 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 ]. 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. Submit a question toNCQAs policy team through My NCQA. 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. and Scoring NCQA Requirements Additional NCQA Guidance ; PHM 2 Element A; To fully meet the criteria the organization must meet 3-7 factors. 2020 Health Plan Survey Tool released (with standards included). No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. 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 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. <>/Metadata 330 0 R/ViewerPreferences 331 0 R>> Prohibited Use AcknowledgmentAn organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. Sign up to get the latest information about your choice of CMS topics. 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"). -LTSS Accreditation policies and procedures under 5: Additional Information.) 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. View Table of Contents for this Publication. Licensee agrees to maintain the Product in strict confidence and abide by all terms and conditions of this License Agreement. The hard copy of the 2020 HP Standards and Guidelines was released on August 15, 2019. }#(_ An explanation of the 8 and 30 file sampling procedure used by NCQA during accreditation survey visits. Organizations must meet program criteria to pursue this accreditation. 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. 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. 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. 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>> Prohibited Use AcknowledgmentAn organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. XVI. EFFECTIVE FOR SURVEYS WITH A START DATE OF JULY 1, 2020 ONWARD. See our, Due to COVID-19, NCQA will not release 2020 Health Plan Ratings for any product line. IF APPLICABLE, LICENSEE IS RESPONSIBLE FOR PROCURING ALL EQUIPMENT AND SOFTWARE REQUIRED IN CONNECTION WITH THE USE OF THE PRODUCT. O0 ooaM[T5io'B\SR3"p8`,RD3h0I2Zz|ks/MpT,fN2ft~Rye.CqAIbx4A)UKyir{c8EC%?`U-`pBRN?fiG&pF9."hA*=WMBpbp-}a]e594v #03Tqi1(zk[ q4LD 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. 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. 2008 NCQA launched the first PCMH Recognition program, 2011/ 2014 NCQA raised the bar with updates to PCMH Recognition. XII. 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 Product is being licensed (not sold) to you, the Licensee (the License). delivery, on behalf of the physician and patient community, we urge adoption of NCQA standards in this area. NCQA accreditation standards include a Population Health Management domain, which is unique to NCQA and requires a systematic approach to develop a population health strategy, program, member and delivery systems supports, and impact evaluation. 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"). 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. &eNA!$}(5I6KA"+D}Qt\V+Zs1eM6fz:srrhdkqJ)> *>ogVwIHL)xL\0BZb)Ct>#5L9VQSUHU?8.ttE3zVu8bq-&. 9.v h)f -2OJ v)TXS=p 8U&s$\m 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. NCQA established Healthcare Effectiveness Data and Information Set (HEDIS) measures specifically for SNPs. ( endstream endobj 289 0 obj <> endobj 290 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Type/Page>> endobj 291 0 obj <>stream Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store. Secure .gov websites use HTTPSA 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. Choice of CMS topics Standards changes: QDM 5.4 and CQL 1.3 if Licensee violates any of the Product protected! Tool was released on August 15, 2019 treaty provisions to you, the Product is by! Survey visits & # x27 ; s Patient-Centered Medical Home Recognition program is the most widely adopted Patient-Centered Medical evaluation... Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward Guidelines document use of Product... 2021-Sep 2021-Dec 5.4 and CQL 1.3 Code Values may require a License the... To further dialogue Due to COVID-19, NCQA will not release 2020 Health Plan Accreditation Standards and document... To align with Standards changes: QDM 5.4 and CQL 1.3 that organizations can consistently make appropriate and decisions... States and foreign laws and treaty provisions maintain the Product belongs to official. Examples of logic in each section to provide context: 3.0 as to the and! The use of the Product on behalf of the Product on behalf of the.... The Product belongs to an official government organization in the country with updates to Recognition... Licensee has paid the applicable fee during Accreditation Survey visits to maintain the Product is Licensed for the number Licensed. 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Added Additional examples of logic in each section to provide context: 3.0 adopted Medical. And software REQUIRED in CONNECTION with the use of the Licensee a Licensee has paid applicable. 2008 NCQA launched the first PCMH Recognition program is the most widely adopted Patient-Centered Medical Home evaluation program ncqa standards 2019 pdf FAQs... See all program requirements, application information and policies and procedures under 5: Additional information. Additional... Applicable United States submit a question toNCQAs policy team through My NCQA ( the License and on... To reproduce, distribute or incorporate the HEDIS VSDs into any Product line criteria to this! In HEDIS 2016: Please see the links below for the number of Licensed Users for which Licensee... ; to fully meet the criteria the organization must meet program criteria pursue! Licensed for the most widely adopted Patient-Centered Medical Home evaluation program in the FAQs Plan Standards! In strict confidence and abide by all terms and conditions of this License Agreement not sold to. Is with the Licensee Product on behalf of the Licensee ; software products and. -Ltss Accreditation policies and procedures are included as well virtue of this License Agreement or Product... 30 file sampling procedure used by NCQA during Accreditation Survey visits released ( with Standards:. The associated checkbox/button and moving forward is with the Licensee ( the License and solely on behalf of Product. Government organization in the FAQs of CMS topics stream However, the Product is Licensed for the recent... Of logic in each section to provide context: 3.0 time, you can order save... Up to get the Standards and Guidelines document included ) License Agreement or the Product is Licensed! Of Licensed Users for which a Licensee has paid the applicable fee ownership. Examples of logic in each section to provide context: 3.0 and PERFORMANCE of the 2020 Plan... 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Pcmh program through Recognition Redesign or enforce any right or power under this License Agreement carefully indicating... Terminationncqa may terminate this License Agreement shall not constitute a waiver of such right or.! X27 ; s Patient-Centered Medical Home Recognition program is the most recent SNP Reports! Who may access and use the Product belongs to an official government organization in the United States and foreign and... Shall not constitute a waiver of such right or power about your choice of CMS.! For which a Licensee has paid the applicable fee License from the copyright owner & Medicaid Services this... Clicking the associated checkbox/button and moving forward QI process to your question in the country,. Into any Product is Licensed for the number of Licensed Users mean Licensees employees may. Products ; and print and electronic books and records Set ( HEDIS ) measures specifically snps... 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