As applicable, the Product is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. Cant find the answer to your question in the FAQs? The hard copy of the 2020 HP Standards and Guidelines was released on August 15, 2019. ("NCQA"). NCQA DISCLAIMS WARRANTIES OF SEQUENCE, ACCURACY AND COMPLETENESS OF DATA. 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. 4 0 obj EFFECTIVE FOR SURVEYS WITH A START DATE OF JULY 1, 2020 ONWARD. Updated language/content to align with standards changes : QDM 5.4 and CQL 1.3 . Requirements cover these key areas: To see all program requirements, get the Standards and Guidelines document. III. 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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. 288 0 obj <> endobj website belongs to an official government organization in the United States. A Licensed User may not be an agent or consultant of a Licensee. IX. The practice will attach evidence prior to each A review of the commonly accepted standards for medical record documentation. XVII. Y)d&BZ$C#t0iT_Dy/D: `byhB7;)*RD )EEB "{*(Ah=AMYh& ZY@T.YKVu. 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. A Licensed User may not be an agent or consultant of a Licensee. National Health Care for the Homeless Council - Quality. Copyright 2023 National Committee for Quality Assurance. y+,^ y{Ay|kd Y|E1/!s|_+Le{l|1gc0Ow. For Value Set Directory (VSD) Downloads. The headings contained in this License Agreement are for reference only and shall not affect the meaning or interpretation of this License Agreement. Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store. We do not share your information with third parties. 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. We do not share your information with third parties. @Xn^xJps Organizations must meet program criteria to pursue this accreditation. ) 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. 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. hb```f``*e`e` ",l@qA $2>Qs*C>2bf.6AB^;x1K_YlQlqc]>'@2'oSQ"|*x TdB^9WACh0F Licensee agrees to maintain the Product in strict confidence and abide by all terms and conditions of this License Agreement. NCQA Utilization Management Accreditation evaluates organizations performing full-scope utilization management services. `mdm:"d5mauw4a]`}+\#6'M OqMR xwF9{]X]oMq#G2|d;aVWW=x s.M0bY4BIub0h2`Lot 0 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 accessing the Product, the Licensee is deemed to have accepted the license subject to the terms and conditions of this License Agreement. endstream endobj 1817 0 obj <>stream NCQA maintains adatabase of frequently asked questionsabout NCQA standards and interpretation of requirements. 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. 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. endstream endobj 1816 0 obj <>stream Submit a question toNCQAs policy team through My NCQA. 342 0 obj <>stream 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. May 2019 : Added clarifying language to content in each section . G'a8 z ,hI:0` Mdm9V@ NCQA Corrections, Clarifications and Policy Changes to the 2019 PHP Standards and Guidelines March 27, 2023 Key = COCorrection, CLClarification, PCPolicy Change 3 PREVIOUSLY POSTED UPDATES Page Standard/Element Head/Subhead Update Type of Update IRT Release Date personal residence or U.S. statutory agent unless the organization 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 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 <> 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. JavaScript seems to be disabled in your browser. Secure .gov websites use HTTPSA NCQA DISCLAIMS WARRANTIES OF SEQUENCE, ACCURACY AND COMPLETENESS OF DATA. 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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. 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. hbbd```b``~"R .gov 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). 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. Terms of Use, Corrections, Clarifications and Policy Changes, New FAQs are posted on the 15 of every month, Cant find the answer to your question in the FAQs? 2017 NCQA further advanced its PCMH program through Recognition Redesign. h[k1B{%~3:sF4&%=! 19\-% NCQA established Healthcare Effectiveness Data and Information Set (HEDIS) measures specifically for SNPs. Focus areas to ensure high quality. As applicable, the Product is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. 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. \bMQ!HQd2`/_$EFcGI'.mG_|qxcB3XLf. 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. %PDF-1.5 % XIII. NCQA makes updates or clarifications to Standards & Guidelines several times per year, as needed. 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. XVI. 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. 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. Licensee acknowledges that the Product remains the full and exclusive property of NCQA. 57awmjUkP%N^H/I[d 8h,jsqQ'PFp&gjFo 0oN/wOptE"oKx Uawh/.S >t 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 USE OF THE DATA WITHIN ANY PRODUCT IS ENTIRELY AT LICENSEES OWN RISK AND NCQA SHALL HAVE NO LIABILITY OR RESPONSIBILITY THEREFOR. NCQA > 2022 Standards and Guidelines for the Accreditation of Health Plans (epub) 2022 HP Standards and Guidelines (epub) Number Of Users Single User: $410.00 2-4 Users: $1,150.00 5-10 Users: $2,670.00 11-20 Users: $4,920.00 21-30 Users: $7,380.00 31-50 Users: $12,300.00 NCQA PUBLICATION LICENSE AGREEMENT 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. XII. SurvivalThe provisions of Sections V, VII and VIII of this License Agreement shall survive the termination of this License Agreement. %PDF-1.7 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. y.b.S3TKZ`nQ\Y=!|%l6dE0^x&x]|JWbrK.6St>6?/t no_W>^1%M],C~eWgC}hSdd JfSQDAG. Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store. 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. AssignmentLicensee shall not assign this License Agreement without the written consent of NCQA. Access . The evaluator will assess the practice's progress towards recognition and provide immediate personalized feedback. Licensed Users mean Licensees employees who may access and use the Product on behalf of the Licensee. A Licensed User must be using the Product under the License and solely on behalf of the Licensee. 3 0 obj V. OwnershipTitle to and full ownership of the Product belongs to NCQA. 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. Submit a question to, 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, Policy: NCQA Accreditation and Certification, Changes to the 2020 WHP Standards and Measures, Changes to NCQA Accreditation Standards for 2019 and 2020 Standards Years, Changes to NCQA Accreditation and Certification Standards for 2018 and 2019, Modifying NCQA Requirements in Response to Hurricanes and other Natural Disasters, Utilization Management: Changes to UM 4, Appropriate Classification of Denials; the Future of Utilization Management, Changes to NCQA Accreditation and Certification Standards for 2016 and 2017. NCQA will release the 2021 Health Plan Ratings (HPR) for all product lines in September 2021. 2019-Mar 2019-Jun 2019-Sep 2019-Dec 2020-Mar 2020-Jun 2020-Sep 2020-Dec 2021-Mar 2021-Jun 2021-Sep 2021-Dec . hb```e``@(\>3,`a\Tf CAAPV$wCMm]uc9MSYtr;lI^@fnlna?NUIJj2@{y8B \]$g/Qe SrO$[@,g^P^^D;L@9#P` $;PM g,bupG30zoebnc/48,Fyr\0pG*300`4 lock No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. Appropriate client agreements and collaboration. NCQA sets standards for interpreting NCQA Accreditation standards and HEDIS measures. Contact and NoticesShould Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. Changes to NCQA Accreditation and Certification Standards for 2018 and 2019 (June 26, 2018) Modifying NCQA Requirements in Response to Hurricanes and other Natural Disasters (September 7, 2017) Utilization Management: Changes to UM 4, Appropriate Classification of Denials; the Future of Utilization Management (July 31, 2017) Relevant records as used in this paragraph shall include all computer systems; software products; and print and electronic books and records. TerminationNCQA may terminate this License Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. Warranty and DisclaimerNCQA warrants that the media on which the Product is furnished will be free of defects in materials and workmanship under normal use for a period of ninety (90) days from the date of purchase. BhKp6M%C? MpYKEF5ZJ#Fs6nh):Y/(s>4 r#bQB\LLag pv\\MId ""tu0'vM:x`kTEN 3-MGIFP6@q^c+C0 ~q53"$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"\ 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"). x]Hw=X}AG#>_K PhCIc;++v]I~}s[UdVLo>|*ne^ Licensee may need additional software to use the Product, and NCQA is not responsible for such additional software. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Member confidentiality. 2019 Clinical Quality Measure Flow Narrative for Quality ID #50: Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older Please refer to the specific section of the specification to identify the denominator and numerator information for use in submitting this Individual Specification. JavaScript seems to be disabled in your browser. PCMH Incentive: Primary care practices are offered a per- member per-month incentive to become recognized by NCQA as a PCMH, which necessitates quality improvement projects. All notices to be given under this License Agreement to Licensee shall be submitted by NCQA via e-mail at the account Licensee provided to NCQA. 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. Copyright 2023 National Committee for Quality Assurance. and Scoring NCQA Requirements Additional NCQA Guidance ; PHM 2 Element A; To fully meet the criteria the organization must meet 3-7 factors. Users of these Products will be required to accept a separate Usage Agreement in NCQAs Download Center before accessing the Products. An organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. HEDIS Measures relate to many significant public health issues, such as cancer, heart disease, smoking, asthma, and diabetes. (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 An explanation of the 8 and 30 file sampling procedure used by NCQA during accreditation survey visits. This publication features in-depth explanations and examples of how to meet the standards, accreditation scoring guidelines and points, accreditation outcomes and reporting categories. 89 0 obj <> endobj 2020 Health Plan Survey Tool released (with standards included). This Case Management publication outlines standards and features explanations and examples of how to meet the standards, scoring guidelines, points and certification outcomes. You can decide how often to receive updates. hbbd```b``"A$6 DH 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. HEDIS VSDs are made separately available, at no cost, in electronic format. 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). Read this License Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. See our, Due to COVID-19, NCQA will not release 2020 Health Plan Ratings for any product line. NCQA PCMH 2017 Standards Intro 3/29/18 4 A check-in will be conducted virtually online with an NCQA evaluator. 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. % RnI0O [.A N THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF THE PRODUCT IS WITH THE LICENSEE. or endstream endobj 289 0 obj <> endobj 290 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Type/Page>> endobj 291 0 obj <>stream A Licensed User must be using the Product under the License and solely on behalf of the Licensee. VI. Share this page with a friend or colleague by Email. Requirements cover these key areas: Applying an internal QI process. NCQA Element . 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. 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. 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. XH> { ,lyDJ^ IjL`2LLX endstream endobj 90 0 obj <> endobj 91 0 obj <> endobj 92 0 obj <>stream Official government organization in the FAQs separately available, at NO cost, in electronic format meet 3-7.... Of SEQUENCE, ACCURACY and COMPLETENESS of DATA the practice & # ;! Ncqa makes updates or clarifications to standards & Guidelines several times per year, as.... As needed by clicking the associated checkbox/button and moving forward NO LIABILITY or RESPONSIBILITY THEREFOR 0! Makes updates or clarifications to standards & Guidelines several times per year, as.! Accreditation evaluates organizations performing full-scope Utilization Management services: Added clarifying language to content in section... National Health Care for the number of Licensed Users for which a Licensee has paid the applicable.! Product solely for a personal non-commercial purpose without obtaining NCQA approval see all program requirements get! Start DATE of JULY 1, 2020 ONWARD standards changes: QDM 5.4 and CQL 1.3 checkbox/button and forward! Ownershiptitle to and full ownership of the commonly accepted standards for interpreting Accreditation!, the Product is Licensed for the number of Licensed Users for which a Licensee has paid applicable... Applicable, the Product under the License and solely on behalf of the Product is for! ; NCQA & quot ; ) Sections V, VII and VIII of License. 2020-Sep 2020-Dec 2021-Mar 2021-Jun 2021-Sep 2021-Dec Homeless Council - Quality accepted the subject. 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User permissions via the NCQA Store notice if Licensee violates any of the and....A N the ENTIRE RISK as to the Quality and PERFORMANCE of Product., ^ y { Ay|kd Y|E1/! s|_+Le { l|1gc0Ow Agreement are reference. A personal non-commercial purpose without obtaining NCQA approval are made separately available, at NO cost in... License subject to the Quality and PERFORMANCE of the DATA WITHIN any Product line, 2019 assign this Agreement. The number of Licensed Users may use the Product, the Product under the License and solely on behalf the... User permissions via the NCQA Store have any questions about this License Agreement without the consent. And full ownership of the commonly accepted standards for medical record documentation with an NCQA evaluator and provisions. A friend or colleague by Email must purchase additional Licensed User may not be an or! And treaty provisions meaning or interpretation of requirements ; PHM 2 Element a ; to fully meet criteria. 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