ncqa standards 2019 pdf

ncqa standards 2019 pdf2020/09/28

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SNPs reported the following measures in HEDIS 2016: Please see the links below for the most recent SNP HEDIS Reports released by NCQA. % Upon termination of this License Agreement, all rights under this License Agreement, including the license granted to Licensee, will cease. SurvivalThe provisions of Sections V, VII and VIII of this License Agreement shall survive the termination of this License Agreement. 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. 0 The Product is being licensed (not sold) to you, the Licensee (the License). 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Added additional examples of logic in each section to provide context : 3.0 . endstream endobj 289 0 obj <> endobj 290 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Type/Page>> endobj 291 0 obj <>stream 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"). <> VIII. means youve safely connected to the .gov website. Relevant records as used in this paragraph shall include all computer systems; software products; and print and electronic books and records. VI. 2 0 obj 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. 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Share sensitive information only on official, secure websites. 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. . We do not share your information with third parties. XV. 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Delegation Best Practices Frank Stelling October 2019 5 Predelegation Evaluation NCQA reviews delegation arrangements initiated in the look-back period Score of 100% for NCQA-accredited or NCQA-certified delegates Best Practice: Evaluate delegate's experience with NCQA requirements, contact other clients V. OwnershipTitle to and full ownership of the Product belongs to NCQA. endobj Licensed Users mean Licensees employees who may access and use the Product on behalf of the Licensee. _iMt{Jkz-N!}=r`ZuM]C8@Mae_#&9nIc%(T,|dcQR4o7J:Vle*O!bB}Y?2a8is^a )OfK;l=B[]=5.Bm:$* 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. No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. 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. 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. 4O?g{d~F&[EecTvH3=xbfU21vQ 8 NCQA Utilization Management Accreditation is designed to ensure that organizations can consistently make appropriate and timely decisions. IX. A Licensed User must be using the Product under the License and solely on behalf of the Licensee. 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. XIV. Users of these Products will be required to accept a separate Usage Agreement in NCQAs Download Center before accessing the Products. You will be prompted to log in to your NCQA account. ("NCQA"). 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. hbbd```b``~"R G'a8 z ,hI:0` Mdm9V@ 2F%At/|b^-x({N&R26y H4>1=.~MClx-ikqGbg 3 0 obj The hard copy of the 2020 HP Standards and Guidelines was released on August 15, 2019. Focus areas to ensure high quality. endobj As applicable, the Product is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. 2017 NCQA further advanced its PCMH program through Recognition Redesign. Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store. 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. 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). x #-;g'bI&Z$@DD*.-;7Wu:orWm\|~uQmx! Copyright 2023 National Committee for Quality Assurance. .gov A Licensed User may not be an agent or consultant of a Licensee. 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. We anticipate, in 2019, further state legislative action to ensure health plans meet requisite standards for hospital-based physician network adequacy. 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. Appropriate client agreements and collaboration. The License is not transferable from Licensee to any other person, entity, organization or association. XII. 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. stream 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. Licensee means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the License Agreement terms below. 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. For the best experience on our site, be sure to turn on Javascript in your browser. II. 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. 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. TerminationNCQA may terminate this License Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. However, the 2020 Health Plan Survey Tool was released on March 30, 2020. 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