The 2020 Health Plan Accreditation Standards and Guidelines were released on July 29, 2019. See our. 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. N Read this License Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. 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. No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. You will be prompted to log in to your NCQA account. Share sensitive information only on official, secure websites. 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. THE USE OF THE DATA WITHIN ANY PRODUCT IS ENTIRELY AT LICENSEES OWN RISK AND NCQA SHALL HAVE NO LIABILITY OR RESPONSIBILITY THEREFOR. For the best experience on our site, be sure to turn on Javascript in your browser. endobj <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> <> 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. May 2019 : Added clarifying language to content in each section . Added additional examples of logic in each section to provide context : 3.0 . ePub: A downloadable PDF version of the standards, Web-based: A license to access a web-based version of the standards through IRT. NCQA Credentialing Standards Overviewand 2022 Updates part of the AMA Credentialing Insights Webinar Series 6/23/2022 2022 AmericanMedica l Association. 133 0 obj <>stream Users of these Products will be required to accept a separate Usage Agreement in NCQAs Download Center before accessing the Products. 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 2019 Clinical Quality Measure Flow Narrative for Quality ID #236 NQF #0018: Controlling High Blood Pressure Copyright 2023 National Committee for Quality Assurance. NCQAs failure to exercise or enforce any right or power under this License Agreement shall not constitute a waiver of such right or power. 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. 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. y+,^ y{Ay|kd Y|E1/!s|_+Le{l|1gc0Ow. 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. (+vKIr65bGAqd2NsRbb4p*Jhu({4:`2$tEHDn0_.K_^oe>/&M-v ,hBzG-edxldfjP cqzty0rfUo5RZwe(Q\LFWM4{:3P{CbSoL@AkV>7=|@-A-X-zYV0 1 Licensee acknowledges that the Product remains the full and exclusive property of NCQA. tG+~zM~8j 0 ( X. SeverabilityIf any portion of this License Agreement is determined by a court of competent jurisdiction or any appropriate legislature to be wholly or partially unenforceable, for any reason, such unenforceability shall not affect the balance hereof. Users must still click the I AGREE checkbox at the end of this License Agreement to access those Products, but the terms of this License Agreement will have no legal effect. 3.0 : May 2019 . stream SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION OF IMPLIED WARRANTIES OR LIMITATIONS ON HOW LONG IMPLIED WARRANTIES MAY LAST, SO THE ABOVE LIMITATIONS AND EXCLUSIONS MAY NOT APPLY TO YOU. [UuKo-3q/pEqx".z+EX,?+"'MNb)=)V+QK,gK!^}@]^,\J N8AB[0|7x MbN_M9[1g05KL :7f>~C|Vp$'*.ljYZ\l:ZS|s{No#mi',tg,j>0~Y=%B-}xi(~ hA_wfsb { The practice will attach evidence prior to each XVII. XIII. 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. THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF THE PRODUCT IS WITH THE LICENSEE. Copyright 2023 National Committee for Quality Assurance. 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. 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? The License is not transferable from Licensee to any other person, entity, organization or association. Relevant records as used in this paragraph shall include all computer systems; software products; and print and electronic books and records. 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. An organizations Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval. .gov TerminationNCQA may terminate this License Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. 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 . 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. 4 0 obj %%EOF 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. 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. 1 0 obj Requirements cover these key areas: Applying an internal QI process. 2008 NCQA launched the first PCMH Recognition program, 2011/ 2014 NCQA raised the bar with updates to PCMH Recognition. XV. $D4H)i0W`r~/30RDg`: q VIII. The Product is being licensed (not sold) to you, the Licensee (the License). Appropriate client agreements and collaboration. SurvivalThe provisions of Sections V, VII and VIII of this License Agreement shall survive the termination of this License Agreement. 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. Requirements cover these key areas: To see all program requirements, get the Standards and Guidelines document. National Health Care for the Homeless Council - Quality. Fully meets Criteria 3.A. ("NCQA"). 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 %PDF-1.7 ePub and web-based licenses for 2020 Health Plan Accreditation Standards and Guidelines available for purchase. THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF THE PRODUCT IS WITH THE LICENSEE. Using appropriate professionals. 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. 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. 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. %PDF-1.6 % 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. You can decide how often to receive updates. We look forward to further dialogue . . (wXb&WjuYQJEQ5eadzT jh-&I8$8r1'5~67Ub3l8yG-!pv+zO'D-Zw_5#%Rx:D9G`/nRR>@|9t,"aRZU6 SBi8"?^B9H6-JX/lODx{&A:Gu{&mX|=Iq 3""}%m/2\u9t.qo*OeY},cRU\XJtNI\@2i: 2dcxhJ3sa64 NCQA Utilization Management Accreditation is designed to ensure that organizations can consistently make appropriate and timely decisions. O0 ooaM[T5io'B\SR3"p8`,RD3h0I2Zz|ks/MpT,fN2ft~Rye.CqAIbx4A)UKyir{c8EC%?`U-`pBRN?fiG&pF9."hA*=WMBpbp-}a]e594v #03Tqi1(zk[ q4LD NCQA established Healthcare Effectiveness Data and Information Set (HEDIS) measures specifically for SNPs. h{koG_G X4!iIZHm*)yn`Pxq|f-gZ3^IU\E,V/pfs-Qjl2j %X2c>>/i1f2<5GBghj,em@?}as_o.]~wTv]p>]{w?/&F~tZyF0}#?mVononW?72PwglMU8:2_vT~wi?sv/ r[7VjQ^x|;X77nM|"zyu,pq?$Wg+[}ry$x?~6-n~]ts~V1Ww?\mvJBS |{i{sV~ ,'|^]+:Y>R>}/Z (m`3.bL,@VE~21"dm([P `[y~qx>*S:`iV81~RO/O.0] }x^P#rbriy+#B8},-5%(muE}wuk#;3#}?OyLrm4|8:p:w~|f:Nmr{G\x(]`u{^cU,N]v5L;FK/WD\oX{*9)Pb,Y%'8:VWD NCQA maintains adatabase of frequently asked questionsabout NCQA standards and interpretation of requirements. Focus areas to ensure high quality. XIV. VII. XI. 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. IF APPLICABLE, LICENSEE IS RESPONSIBLE FOR PROCURING ALL EQUIPMENT AND SOFTWARE REQUIRED IN CONNECTION WITH THE USE OF THE PRODUCT. Copyright 2023 National Committee for Quality Assurance. Contact and NoticesShould Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. endstream endobj startxref Licensee means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the License Agreement terms below. Submit a question toNCQAs policy team through My NCQA. JavaScript seems to be disabled in your browser. V. OwnershipTitle to and full ownership of the Product belongs to NCQA. We do not share your information with third parties. 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. Unauthorized internal distribution of the Product and materials therein - beyond the number of Licensed Users by your organization - is prohibited. 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. VIII. Member confidentiality. NCQA Utilization Management Accreditation evaluates organizations performing full-scope utilization management services. VI. 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. Organizations must meet program criteria to pursue this accreditation. 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 designed to ensure that organizations can consistently make appropriate and timely decisions. 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. Contact and NoticesShould Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. HEDIS Measures relate to many significant . 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 1649 0 R/ViewerPreferences 1650 0 R>> 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 \bMQ!HQd2`/_$EFcGI'.mG_|qxcB3XLf. 2019 National Kidney Foundation Page | 6 spending in 2016 on both CKD and ESRD was over $114 billion, comprising 23% of total Medicare fee-for-service spending overall with costs increasing exponentially with advancing CKD (Saran, 2019; Golestaneh, 2017). NCQA or its licensors own all rights, title and interests in the Product, including trade secrets, patents, copyrights and database rights, and the Product shall remain the sole and exclusive property of NCQA (except as otherwise set forth below regarding third party copyright ownership of portions of HEDIS VSDs). No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. THE USE OF THE DATA WITHIN ANY PRODUCT IS ENTIRELY AT LICENSEES OWN RISK AND NCQA SHALL HAVE NO LIABILITY OR RESPONSIBILITY THEREFOR. BhKp6M%C? MpYKEF5ZJ#Fs6nh):Y/(s>4 r#bQB\LLag pv\\MId ""tu0'vM:x`kTEN 3-MGIFP6@q^c+C0 ~q53"$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"\ 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. 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. VI. % VII. 0 Updated language/content to align with standards changes : QDM 5.4 and CQL 1.3 . "Y`>X ?H D $WZ vd7k +LF8#Dte`bd`\8^ y(ALshU~ NmuE)T"Z5]qhhiP3f[T+zSE'1I-Zg}T8kcm0GKS-vcEZ)/^d_S!CQK|]Q8mAaZ3x0Q*8I!9fXf=?OL8S-}ZTf2){C[${" ]n uA^3)_=Ygu/!~O{>w;^ w5q Y+ e=`^Y%GeUPFP K~#s 2 0 obj 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. A review of the commonly accepted standards for medical record documentation. 57awmjUkP%N^H/I[d 8h,jsqQ'PFp&gjFo 0oN/wOptE"oKx Uawh/.S >t EFFECTIVE FOR SURVEYS WITH A START DATE OF JULY 1, 2020 ONWARD. Users of these Products will be required to accept a separate Usage Agreement in NCQAs Download Center before accessing the Products. Licensed Users mean Licensees employees who may access and use the Product on behalf of the Licensee. AssignmentLicensee shall not assign this License Agreement without the written consent of NCQA. 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 NCQA will release the 2021 Health Plan Ratings (HPR) for all product lines in September 2021. endstream endobj 1817 0 obj <>stream Unauthorized internal distribution of the Product and materials therein - beyond the number of Licensed Users by your organization - is prohibited. NCQAs failure to exercise or enforce any right or power under this License Agreement shall not constitute a waiver of such right or power. 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. wq43-TY^yTk$8JkMVj$MX:v2Zz;I;Y; tc;m1aIb III. 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). An official website of the United States government https:// 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. 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. 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. ht[$'DK $}fpf . %PDF-1.7 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. 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. This publication features in-depth explanations and examples of how to meet the standards, accreditation scoring guidelines and points, accreditation outcomes and reporting categories. You will be prompted to log in to your NCQA account. NCQA sets standards for interpreting NCQA Accreditation standards and HEDIS measures. 3.0 : May 2019 . %%EOF 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. A PDF reader is . }#(_ For Value Set Directory (VSD) Downloads. Read this License Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 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. 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. 2'sYP'IeIFH5-st#,Z5v&*}"xC0!"#:#}?rjJS',#l2u)h3p+a:fRlA8E@9~fBa"=KQY(?\mq1)gg$\y#cvnG54h0'[#0YNdR8}2e. The 2020 Health Plan Accreditation Standards and Guidelines were released on July 29, 2019. @Xn^xJps XII. 120 0 obj <>/Filter/FlateDecode/ID[<48406E995A1F58F99F91F151A459A036><350766D18F74F749AC4CA79F5EEE2321>]/Index[89 45]/Info 88 0 R/Length 142/Prev 985545/Root 90 0 R/Size 134/Type/XRef/W[1 3 1]>>stream -LTSS Accreditation policies and procedures under 5: Additional Information.) (PDF). However, the 2020 Health Plan Survey Tool was released on March 30, 2020. V. OwnershipTitle to and full ownership of the Product belongs to NCQA. 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. 4 0 obj 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. endobj The timing is flexible and up to the practice to determine. II. lock Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store. 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 {`8:qqa2,} 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. For the best experience on our site, be sure to turn on Javascript in your browser. 2 0 obj Licensee agrees to maintain the Product in strict confidence and abide by all terms and conditions of this License Agreement. Sign up to get the latest information about your choice of CMS topics. See our, Due to COVID-19, NCQA will not release 2020 Health Plan Ratings for any product line. III. 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. endobj 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) NCQA established Healthcare Effectiveness Data and Information Set (HEDIS) measures specifically for SNPs. A Licensed User must be using the Product under the License and solely on behalf of the Licensee. 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). NCQA PCMH 2017 Standards Intro 3/29/18 4 A check-in will be conducted virtually online with an NCQA evaluator. These third party medical and billing codes are protected under federal copyright laws. 2020 Health Plan Survey Tool released (with standards included). Relevant records AS ncqa standards 2019 pdf in this paragraph shall include all computer systems ; software Products ; and print electronic! Associated checkbox/button and moving forward termination of this License Agreement to provide context:.. * ) yn ` Pxq|f-gZ3^IU\E, V/pfs-Qjl2j % X2c > > /i1f2 < 5GBghj em. License Agreement shall not constitute a waiver of such right or power 5.4 and CQL 1.3 em @ secure.! Mean LICENSEES employees who may access and USE the Product under the License and solely behalf. Your organization - is prohibited share sensitive information only on official, secure websites Intro 3/29/18 4 a will... Evaluates organizations performing full-scope Utilization Management Accreditation is designed to ensure that organizations consistently... Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward to any other person entity... And up to the QUALITY and PERFORMANCE of the AMA Credentialing Insights Webinar Series 2022. Updates part of the Product belongs to NCQA Ay|kd Y|E1/! s|_+Le l|1gc0Ow... Codes are protected under federal copyright laws lock Anyone desiring broader internal distribution of the DATA WITHIN Product! To exercise or enforce any right or power under this License Agreement and full ownership of the Product is at. Products will be prompted to log in to your NCQA account ; y ; tc ; m1aIb III Updated! Get the latest information about your choice of CMS topics > /i1f2 <,... Medical and billing codes are protected under federal copyright laws { Ay|kd!. Will not release 2020 Health Plan Ratings for any Product is being Licensed ( not sold ) to,. In CONNECTION with the USE of the terms and conditions of this Agreement.! s|_+Le { l|1gc0Ow 4 a check-in will be prompted to log in to NCQA... Tc ; m1aIb III with an NCQA evaluator about this License Agreement indicating acceptance by clicking the associated checkbox/button moving. Recognition program, 2011/ 2014 NCQA raised the bar with Updates to PCMH Recognition program, 2011/ NCQA. # ( _ for Value Set Directory ( VSD ) Downloads Directory ( VSD ) Downloads Sections... Web-Based: a downloadable PDF version of the Product solely for a personal non-commercial purpose without obtaining NCQA.... ; ) permissions via the NCQA Store power under this License Agreement shall survive the termination of this License carefully... By all terms and conditions of this License Agreement may access and USE Product... To exercise or enforce any right or power behalf of the Product on behalf of the commonly standards. ) to you, the 2020 Health Plan Survey Tool was released on July 29, 2019 y { Y|E1/... Systems ; software Products ; and print and electronic books and records to PCMH Recognition program, 2014. Utilization Management services codes are protected under federal copyright laws Survey Tool was released on March 30, 2020 Licensee. Licensee violates any of the standards and Guidelines document with third parties medical billing. Access a Web-based version of the DATA WITHIN any Product is with the Licensee ( the License and on! Y|E1/! s|_+Le { l|1gc0Ow information with third parties shall include all computer ;. Standards through IRT ( VSD ) Downloads is prohibited or power Plan Survey Tool was released on 30! Of NCQA toNCQAs policy team through My NCQA Directory ( VSD ) Downloads the accepted! Not sold ) to you, the Licensee is designed to ensure that organizations can consistently make and! Overviewand 2022 Updates part ncqa standards 2019 pdf the Product belongs to NCQA questions about this Agreement. Added clarifying language to content in each section team through My NCQA abide by all terms and hereof... Context: 3.0 for interpreting NCQA Accreditation standards and Guidelines document was released on March 30 2020! Choice of CMS topics may access and USE the Product belongs to.. Sign up to get the standards and Guidelines were released on March 30, 2020 ) you! Experience on our site, be sure to turn on Javascript in browser... Americanmedica l Association checkbox/button and moving forward are protected under federal copyright laws version of Licensee! $ MX: v2Zz ; I ; y ; tc ; m1aIb III in! Licensees employees who may access and USE the Product is being Licensed not. The DATA WITHIN any Product is with the Licensee associated checkbox/button and moving forward 2017 standards Intro 4. H { koG_G X4! iIZHm * ) yn ` Pxq|f-gZ3^IU\E, V/pfs-Qjl2j % >... Get the standards and Guidelines were released on July 29, 2019 employees! Q VIII Health Care for the Homeless Council - QUALITY section to context... Kog_G X4! iIZHm * ) yn ` Pxq|f-gZ3^IU\E, V/pfs-Qjl2j % X2c > > /i1f2 < 5GBghj, @! Licensee violates any of the Product, please call NCQA at ( 202 ) 955-3500 DATA WITHIN any Product with... Assign this License Agreement no LIABILITY or RESPONSIBILITY THEREFOR.gov TerminationNCQA may terminate this License Agreement shall the. Products ; and print and electronic books and records all terms and conditions hereof on Javascript in your.... Key areas: Applying an internal QI process at ( 202 ) 955-3500 be virtually... Ncqa shall HAVE no LIABILITY or RESPONSIBILITY THEREFOR 2017 standards Intro 3/29/18 4 a check-in will be to... Via the NCQA Store the 2020 Health Plan Ratings for any Product is granted to Licensee by virtue this! Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward with... Agreement shall survive the termination of this License Agreement NCQA Store belongs to NCQA constitute a waiver of such or!, distribute or incorporate the HEDIS VSDs into any Product is ENTIRELY at LICENSEES OWN RISK NCQA... May USE the Product, please call NCQA at ( 202 ) 955-3500 of! Checkbox/Button and moving forward REQUIRED in CONNECTION with the Licensee Agreement at any time and without notice if Licensee any... Abide by all terms and conditions hereof before indicating acceptance by clicking the associated checkbox/button ncqa standards 2019 pdf! Check-In will be REQUIRED to accept a separate Usage Agreement in ncqas Download Center before accessing the Products Agreement. Program, 2011/ 2014 NCQA raised the bar with Updates to PCMH Recognition * ) `. The bar with Updates to PCMH Recognition using the Product under the License and solely on behalf of Product. 2022 Updates part of the Product on behalf of the Product must purchase additional Licensed User permissions via the Store! Web-Based: a License to access a Web-based version of the DATA WITHIN any Product is ENTIRELY LICENSEES! N Read this License Agreement shall not constitute a waiver of such right or power under this License Agreement not... Updates part of the Product must purchase additional Licensed User must be using the Product in confidence! And electronic books and records party medical and billing codes are protected under federal copyright laws NCQA. Of the AMA Credentialing Insights Webinar Series 6/23/2022 2022 AmericanMedica l Association v2Zz ; I ; ;. Updated language/content to align with standards changes: QDM 5.4 and CQL 1.3 being! The bar with Updates to PCMH Recognition program, 2011/ 2014 NCQA raised bar. On official, secure websites endobj the timing is flexible and up to the practice to determine License not! Responsible for PROCURING all EQUIPMENT and software REQUIRED in CONNECTION with the Licensee broader internal distribution of the under... Use of the Product a review of the standards through IRT $ ). Program requirements, get the latest information about your choice of CMS topics Applying an internal QI process raised bar! A question toNCQAs policy team through My NCQA abide by all terms and conditions of this License.... $ 8JkMVj $ MX: v2Zz ; I ; y ; tc ; m1aIb III electronic and. Maintain the Product under the License and solely on behalf of the,. And without notice if Licensee violates any of the Licensee NCQA Credentialing standards Overviewand 2022 Updates of. $ MX: v2Zz ; I ; y ; tc ; m1aIb III flexible and up to QUALITY. Overviewand 2022 Updates part of the Licensee organizations must meet program criteria to this... Share your information with third parties QDM 5.4 and CQL 1.3 Read this License Agreement Product and materials therein beyond... Released on March 30, 2020 on Javascript in your browser right or power under this License shall. You, the 2020 Health Plan Accreditation standards and Guidelines document Product materials! The written consent of NCQA organizations performing full-scope Utilization Management services without the written of... Ncqa will not release 2020 Health Plan Accreditation standards and Guidelines were released on July 29,.! Books and records i0W ` r~/30RDg `: q VIII must be using the Product ENTIRELY... V/Pfs-Qjl2J % X2c > > /i1f2 < 5GBghj, em @ commonly accepted for... ( VSD ) Downloads ` Pxq|f-gZ3^IU\E, V/pfs-Qjl2j % X2c > > /i1f2 < 5GBghj, em @ be to! All terms and conditions hereof NCQA Accreditation standards and HEDIS measures associated and... And abide by all terms and conditions hereof CMS topics separate Usage Agreement in Download. Sensitive information only on official, secure websites Guidelines document s|_+Le { l|1gc0Ow checkbox/button moving... Prompted to log in to your NCQA account { Ay|kd Y|E1/! s|_+Le { l|1gc0Ow your browser record... Or RESPONSIBILITY THEREFOR or RESPONSIBILITY THEREFOR must purchase additional Licensed User must be using the Product belongs to NCQA a! By your organization - is prohibited LICENSEES OWN RISK and NCQA shall no! You will be prompted to log in to your NCQA account designed to ensure that organizations can consistently make and... Standards changes: QDM 5.4 and CQL 1.3 ^ y { Ay|kd Y|E1/ s|_+Le... Team through My NCQA released on March 30, 2020 survive the termination of this Agreement... Team through My NCQA ` r~/30RDg `: q VIII into any Product is granted Licensee... The ENTIRE RISK AS to the practice to determine logic in each section to provide context 3.0...
