0000043130 00000 n 0000043593 00000 n Give your county office your updated contact information so you can stay enrolled. A dated graphic sheet . Licensee may not allow a third party to view or use HEDIS Volume 2. 0000016662 00000 n hbbd```b`x"/I0yDHw`-R H2b;HWYH|&" 4H F ,{L `s?mm&F "3  0000039528 00000 n 0000027069 00000 n 8288 0 obj <>/Filter/FlateDecode/ID[<69BCAFE65C18E142B8D25016BEF95C84><8F47EB867E2FB34A83FE6FC176ECE178>]/Index[8259 56]/Info 8258 0 R/Length 131/Prev 972378/Root 8260 0 R/Size 8315/Type/XRef/W[1 3 1]>>stream Administrative Measure Quick Guide with Codes . In effectuating its obligations hereunder, Licensee shall not consent to the entry of a judgment or otherwise settle any claim against NCQA, in which NCQA shall be obligated to make any admission of fault, liability or wrongdoing or otherwise involve any prejudice of its interests without the prior written consent of NCQA, which shall not be unreasonably withheld, delayed or conditioned. 0000009376 00000 n %%EOF 0000039652 00000 n 0000004105 00000 n 0000002775 00000 n 0000004508 00000 n IMPORTANT: Are you enrolled in Medi-Cal? See how we support the vision of everyone having fair and just opportunities to be as healthy as possible. 0000040184 00000 n View Table of Contents for this Publication. Licensed Users mean Licensees employees who may access and use HEDIS Volume 2 on behalf of the Licensee. 2022. / 7nuT.,qUN^UNws}a9z6^.WU'_, rQTULzX{3yq\9$`IKz128~LVPwZZ8/8}W6!e2=M!\K!;.^)`'>F=D;D5L>5PfOTx) 0000042055 00000 n L$8d^HA2^h[,=%!kSyG)Je;'_ )*+n=8PR!0wSWk cE"Mos_|%,plTowGw6H`@)K'Ixxl/hLW}NGhu6)_TrOsX}X%%Vp(G(Z$sE4io\V_3|]raigYZ]Wy>j(Sg+25K4 n/AWa?5$3/) YDD;&4DP&qyL+#^49y)9Ram#XiX}! REQUIRED HEDIS1 AND CAHPS2 MEASURES FOR HEDIS REPORTING YEAR 2022 Summary of Changes to Measure List: Added the following measures. 0000037498 00000 n 0000037381 00000 n 0000040259 00000 n hbbd```b`` @$SdId:lZ ] DHV~'l g" 1D]3@{@Wn``W ! 0000011749 00000 n NCQA may terminate this Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. 0000037764 00000 n HEDIS is a set of standardized measures that specifies how organizations collect, audit and report performance information across the most pressing clinical areas, as well as important dimensions of customer satisfaction and patient experience. L.A. Care Health Plan, A Public Entity 2000-2023Local Initiative Health Authority For Los Angeles County, Clinical Tools to Help You Improve Outcomes, everyone having fair and just opportunities, Elevating the Safety Net 2020 Scholarship Recipients, Additional Elevating the Safety Net Programs, Elevating the Safety Net - Frequently Asked Questions, Elevating the Safety Net - Guiding Principles, Elevating the Safety Net 2018 Scholarship Recipients, Elevating the Safety Net 2019 Scholarship Recipients, Elevating the Safety Net 2021 Scholarship Recipients, Elevating the Safety Net 2022 Scholarship Recipients. 0000309524 00000 n 0000038002 00000 n Updates on HEDIS Measures MY2022 . Have questions about renewing your Medi-Cal? Upon termination, Licensee agrees to immediately return to NCQA or destroy, at NCQAs option, all copies of HEDIS Volume 2, together with any back-up copy, modifications and any merged portions, in any form, in Licensee's possession. The report cards use a standard set of measures called the Healthcare Effectiveness Data and Information Set (HEDIS ).*. 1349 0 obj <> endobj 0000036187 00000 n 0000042845 00000 n 0000108859 00000 n 1171 0 obj <>stream A Licensed User may not be an agent or consultant of a Licensee. Quality measures help ensure our members receive appropriate care. 0000009121 00000 n 0000312745 00000 n Telehealth encounters in . hb```B ce`aB-G_PG 3 0 obj 0000033255 00000 n 0000106227 00000 n YHLdb91{ d 9 PB2%e'c%tPV Q>!dF7\-9.Tr/_HQtvdQY/1g`SEp/HUyG=K>[pCqKI9w4%Vt)l{I)s1(yzv]:L:/dkey~WlXvu5{ Licensee Representation and Warranty: Licensee represents and warrants to NCQA that this Agreement shall be binding on Licensee, and, unless Licensee is an individual, Licensee represents and warrants that this Agreement was executed by an authorized signatory of Licensee with the authority to enter into binding agreements on behalf of Licensee. Unauthorized internal distribution of HEDIS Volume 2 and materials therein - beyond the number of Licensed Users by your organization - is prohibited. 2213 0 obj <>stream endstream endobj startxref ' f it4A@! 0000001550 00000 n Most PDF readers are a free download. 0000310375 00000 n Noncompliance may also disqualify Licensee from receiving future goods and services from NCQA. 0000013020 00000 n 0000306723 00000 n 0000011303 00000 n 0000040760 00000 n hXkTG/@$crvna%Ds]Tl Upon termination of this Agreement, all rights under this Agreement, including the License, will cease. 0000042498 00000 n The obligations of both Parties shall not terminate upon any assignment or delegation attempted without such prior written consent. All Optima Health plans have benefit exclusions and limitations and terms under which the policy may be continued in force or discontinued. 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"). 0000020999 00000 n The clinical information provided is intended to aid in the understanding of HEDIS measures. H\n0E 0000010787 00000 n If any portion of this Agreement is determined by a court of competent jurisdiction or any appropriate legislature or governmental agency to be wholly or partially unenforceable, for any reason, such term shall be deemed to be modified to the minimum extent necessary to comply with such law, ruling or regulation, and the remainder of this Agreement shall not be affected thereby. 0000014698 00000 n %PDF-1.7 % startxref HEDIS MY 2022 Volume 2incorporates the following additional content, providing added value to our customers: The HEDIS measures and specifications contained in HEDIS Volume 2 publication were developed by and are owned by NCQA. Licensee agrees that it will not seek to register any of NCQAs Marks or other indicia consisting of or incorporating any element of the Marks, or variations thereof, in any jurisdictions. 0000001516 00000 n Anyone desiring broader internal distribution of HEDIS Volume 2 must purchase additional Licensed User permissions via the NCQA Store. 0000306648 00000 n NCQA updated telehealth guidance in 40 HEDIS measures for HEDIS MYs 2020 and 2021. 0000021318 00000 n L.A. Care Health Plan representatives are available 24 hours a day, 7 days a week, including holidays to help you. 0000310669 00000 n Sentara Health Plans, Inc. provides administrative services to group and individual health plans but does not underwrite benefits. We created tip sheets to help you satisfy quality measures, including Healthcare Effectiveness Data and Information Set (HEDIS) measures* from the National Committee for Quality Assurance (NCQA). Except as expressly authorized or provided for herein, Licensee shall: (i) only adjust the Licensed Measure Specifications, or any portion thereof, as permitted by the Rules;(ii) not delete or in any manner alter any notices, disclaimers or other legends contained in HEDIS Volume 2 or appearing on any screens, documents or other materials obtained through use of HEDIS Volume 2;(iii) prominently display language as displayed in Section 17 when adjusting the Licensed Measure Specifications as permitted by the Rules; (iv) not use HEDIS Volume 2 (including the Licensed Measure Specifications) or any portion thereof for any purpose other than as specifically set forth in this Agreement;(v) not publicly display, disseminate or publish the HEDIS Volume 2 (including the Licensed Measure Specifications), modifications or adjustments thereof or any portion of the same;(vi) not use the HEDIS VSD or any portion thereof without an authorized license from the copyright owners; (vii) not 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 HEDIS Volume 2;(viii) not transmit HEDSI Volume 2 electronically or allow access to HEDIS Volume 2 over a network or a public computer-based information system which permits access to a greater number of users than licensed by Licensee; (ix) not authorize or permit any third-party or affiliate, subsidiary or related entity to use HEDIS Volume 2 (including the Licensed Measure Specifications) or any portion thereof without NCQA's prior written consent;(x) not identify records or calculate or display any calculated measurement (HEDIS measure result) stemming from the Licensed Measure Specifications;(xi) not reproduce, copy, reverse engineer, decompile or disassemble the Licensed Measure Specifications or prepare derivative works from the Licensed Measure Specifications or any portion thereof t (except that Licensee may make one [1] copy for each Licensed User for which Licensee has purchased a license to use HEDIS Volume 2); and(xii) not ship, transmit, transfer or export Volume 2 (including the Licensed Measure Specifications) or any portion thereof outside of the U.S. or to clients or other end-users primarily located outside of the U.S. 0000014908 00000 n 0000034564 00000 n THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF HEDIS VOLUME 2 IS WITH THE LICENSEE. z$qP` .tu"#d4@IM`88dW]C'[Y_NH`x a 3NM2-o c;QAAQ[ fz:f d`} 9o0 mL endstream endobj 59 0 obj <>>> endobj 60 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/Properties<>/XObject<>>>/Rotate 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page/PieceInfo>/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 0.0 0.0]>>/PageUIDList<0 278>>/PageWidthList<0 612.0>>>>>>>> endobj 61 0 obj <> endobj 62 0 obj <> endobj 63 0 obj <> endobj 64 0 obj <> endobj 65 0 obj <> endobj 66 0 obj <> endobj 67 0 obj <> endobj 68 0 obj [/ICCBased 91 0 R] endobj 69 0 obj <>stream "R6!YV\#VAz\,E0Q{vrW7| Documentation in a standardized prenatal flow sheet, or; b. 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), Quality Compass 2023 (MY 2022) Commercial, Quality Compass 2023 (MY 2022) Exchange Data File, Quality Compass 2023 (MY 2022) Member Experience Data Set, California Align Measure Perform (AMP) & Value Based Pay for Performance (VBP4P), Skip to the beginning of the images gallery. 0000036980 00000 n The License is not transferable from Licensee to any other person, entity, organization or association. Use of the Marks shall inure to the benefit of NCQA. 0000012545 00000 n Optima Preferred Provider Organization (PPO) products are issued and underwritten by Optima Health Insurance Company. More than 90 percent of America's health plans use HEDIS to evaluate performance. 0000044158 00000 n 0000037577 00000 n This License Agreement, along with all materials referenced herein (Agreement), is a legal agreement between the individual or entity purchasing the license to use HEDIS Volume 2 (defined below) (hereinafter the Licensee) and the National Committee for Quality Assurance (NCQA). %PDF-1.6 % Go to benefitscal.com or call the Los Angeles County Department of Public Social Services at 1-866-613-3777. The section headings contained in this Agreement are included for reference only and shall not affect the construction or interpretation of any term in this Agreement. 1111 0 obj <> endobj In addition, some sites may require you to agree to their terms of use and privacy policy. HEDIS MY 2022 includes 96 measures across 6 domains of care: Effectiveness of Care Access/Availability of Care Experience of Care Utilization and Risk Adjusted Utilization Health Plan Descriptive Information Measures Reported Using Electronic Clinical Data Systems How is HEDIS Data Collected? BP taken and reported by member using . 0000311299 00000 n 0000029274 00000 n Sole ownership rights to the Licensed Measure Specifications and any modifications, alterations or adjustments thereof reside with NCQA. Neither Party shall assign or otherwise delegate this Agreement or any rights, duties and/or obligations hereunder without the prior written consent of the other Party. Developed by the National Committee for Quality Assurance (NCQA), it is one of the most widely used set of health . HEDIS Volume 2 is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. Submit this inquiry by logging intoMy NCQA, selecting theAsk a Questionbutton, then theOrdersbutton, then theCustom License Requestsoption. Subject to the terms and conditions of this Agreement, NCQA grants Licensee a personal, limited, non-exclusive, non-transferable license in the United States to use HEDIS Volume 2 during the term of this Agreement solely for internal, non-commercial purposes in accordance with the terms of this Agreement (the License). 0000004537 00000 n 0000010484 00000 n 0000010465 00000 n 0000042933 00000 n NCQA hereby grants to Licensee a non-exclusive, non-transferable license and right to display the below Marks solely in connection with the Licensed Measure Specifications as expressly permitted under this Agreement. 0000042130 00000 n qJ{*ay|UgxEjM&aMzw- hR ZMr 5TW[Q2\Cbyh|#my\?Qj**}g}F 2022. 0000013361 00000 n 2021-2022 HEDIS and VBP TIP Sheet . 0000034175 00000 n 1384 0 obj <>stream The individual accepting this Agreement on behalf of Licensee represents that by electronically signing this Agreement, the individual hereby binds the Licensee to the terms of this Agreement, and that such individual is an employee of Licensee and duly authorized to enter into and bind Licensee to the terms of this Agreement. Licensee means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the Agreement terms below. The following activities are expressly prohibited in connection with the use of HEDIS Volume 2 under this Agreement: 1. 0000002209 00000 n 0000044076 00000 n 0000307212 00000 n 0000012472 00000 n 0000013091 00000 n 0000003724 00000 n 0000029168 00000 n 0000043814 00000 n Rate 1: Six or more well-child visits* 0 to 15 months. 0000043052 00000 n For example, 2022 claims, encounters, and other HEDIS data are submitted throughout 2022. MEASUREDESCRIPTION OF MEASUREDOCUMENTATION TIPSCOMPLIANCE CODES & MEASURE TIPS Prevention and Screening Cervical Cancer Screening (CCS)* endobj 0000004778 00000 n 0000108933 00000 n 0000308347 00000 n Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members, Adult Access to Preventive/Ambulatory Health Services, Annual Dental Visit for Children and Adolescents, Appropriate Testing for Children with Pharyngitis, Appropriate Treatment for Upper Respiratory Infection, Kidney Health Evaluation for Patient with Diabetes, Use of Spirometry Testing in Assessing and Diagnosing COPD, Diabetes Screening forPeople with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications, Follow-Up After Emergency Department Visit for Substance Use, Follow-Up After Emergency Department Visit for Mental Illness, Follow Up After Hospitalization for Mental Illness, Follow-Up Care for Children Prescribed ADHD Medication, Initiation and Engagementof Substance Use DisorderTreatment, Metabolic Monitoring for Children and Adolescents on Antipsychotics, Social Need Screening and Intervention (SNS-E). HEDIS Volume 2 and the Licensed Measure Specifications expressly exclude all third-party code . 0000033807 00000 n Optima Health Medicare, Medicaid, and FAMIS programs are administered under agreements with Optima Health and the Centers for Medicare and Medicaid Services (CMS) and the Virginia Department of Medical Assistance Services (DMAS). 0000007623 00000 n Licensee may use NCQAs registered trademark HEDIS only when describing the Licensed Measure Specifications as permitted under this Agreement, and to refer to the HEDIS measure specifications for the relevant year. %PDF-1.6 % <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 0000036108 00000 n 0000003432 00000 n For the best experience on our site, be sure to turn on Javascript in your browser. 0000011383 00000 n 1111 61 0000039017 00000 n 0000014954 00000 n 0000033741 00000 n 0000106048 00000 n 0000028129 00000 n One option is Adobe Reader which has a built-in reader. oaoNNg. Prohibited Use AcknowledgementAn organizations Licensed Users may use HEDIS Volume 2 solely for a personal non-commercial purpose without obtaining NCQA approval. xn0#eR;TUj!@iFQ;6t$-h4Lblp|FC''p6@b^{|K@i&!MBot&ji`Wix P)V(K+Yn*g^\(5%ha Refer to your state's guidance for payment details and telehealth regulations. 0000006599 00000 n 0000010580 00000 n 0000308812 00000 n CAHPSCAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). 0000309151 00000 n 0000307846 00000 n 0000013372 00000 n 0000029485 00000 n 0000029735 00000 n 0000031527 00000 n 0000041005 00000 n It is not intended to influence clinical and coding judgment. 0000032558 00000 n WHEREAS, NCQA is an independent non-profit organization widely recognized as the authority on the quality of health plans; WHEREAS, NCQA has developed specifications for the Healthcare Effectiveness Data and Information Set (HEDIS) measures and specifications to standardize the collection and reporting of health plan quality information and the survey specifications for the Consumer Assessment of Healthcare Providers and Systems (CAHPS); WHEREAS, NCQA publishes HEDIS Volume 2: Technical Specifications for Health Plans (HEDIS Volume 2) that includes the HEDIS Value Set Directory (HEDIS VSD) that crosswalks HEDIS to third party medical and billing codes; WHEREAS, HEDIS Volume 2 also includes the Rules for Allowable Adjustments of HEDIS (the Rules), that prescribes guidelines for adjusting NCQAs HEDIS measures and specifications; WHEREAS, Licensee desires to use HEDIS Volume 2; and. Below is a summary of some of the key changes to be aware of: Diabetes measures. 0000043182 00000 n The National Committee for Quality Assurance (NCQA) developed the HEDIS measures. For HEDIS related inquiries, please contact [email protected]. 0000005408 00000 n External link You are leaving this website/app (site). !N8X efI~wh73Q>oVZ+ cmG!gV?ngR~7rUCZEOA`3t= pO] Vv 5wq26mxvBh. 0000013780 00000 n 0000042710 00000 n Has your contact information changed in the past two years? 0000040601 00000 n %%EOF 0000029379 00000 n %%EOF Order educational materials for your patients. 0000037613 00000 n x\B+C8 ssVj'. startxref 0000002956 00000 n and improve Quality Incentive Program earnings potential through the use of HEDIS reference sheets that include: Measure descriptions Age ranges Billing and diagnosis codes for each measure Tips and strategies for improving measure performance 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 HEDIS VOLUME 2 OR ANY PART THEREOF, OR THIS AGREEMENT, EXCEED THE PRICE PAID FOR HEDIS VOLUME 2, WHETHER SUCH LIABILITY ARISES FROM ANY CLAIM BASED ON CONTRACT, WARRANTY, TORT OR OTHERWISE. Recognizing that HEDIS measures have traditionally been specified for health plan reporting, NCQA developed the Rules for Allowable Adjustment of HEDIS to accommodate the application of HEDIS measures to various levels of the health care system for quality improvement initiatives. 0000313326 00000 n 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 HEDIS Volume 2 does not constitute a preliminary or final score and does not predict achievement of accreditation, certification or recognition, as applicable. LICENSEE IS RESPONSIBLE FOR PROCURING ALL EQUIPMENT AND SOFTWARE REQUIRED IN CONNECTION WITH THE USE OF HEDIS VOLUME 2. This Agreement is not intended to and shall not be construed to give any third party any interest or rights (including, without limitation, any third-party beneficiary rights) with respect to or in connection with any agreement or provision contained herein or contemplated hereby. 0000006919 00000 n 0000308048 00000 n 0000000016 00000 n 0000023321 00000 n Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 0000072352 00000 n 0000028427 00000 n 0000038081 00000 n HEDIS is a nationally standardized set of measures related to important areas of care and service. 0000041082 00000 n digital device in . 0000011225 00000 n With respect to any and all claims brought by a third party, Licensee shall promptly notify NCQA of such claim and the Licensee shall have the right, at its sole discretion, to defend and control any action or proceeding with respect to such claim. <> 0000033334 00000 n Definitions: 1.1 "Licensed Measure Specifications" shall mean NCQA's HEDIS measures and specifications and HEDIS CAHPS survey measures and specifications detailed in HEDIS Volume 2 (including the Rules), subject to payment of any related fees. 0000041498 00000 n trailer <<544F2374A80A4621986B17D4733DBC3A>]/Prev 388715>> startxref 0 %%EOF 118 0 obj <>stream The site may also contain non-Medicare related information. Disclaimer: The summary specifications for measures reported using electronic clinical data systems (ECDS) that are included in the Volume 2 publication are for reference purposes only and should not be used for programming or reporting of the measures. 0000042169 00000 n 0000092876 00000 n Blue Cross and Blue Shield of Illinois (BCBSIL) reports audited Healthcare Effectiveness Data and Information Set (HEDIS) results. 2022. 0000014342 00000 n THIS WARRANTY IS IN LIEU OF ALL OTHER WARRANTIES, EITHER EXPRESS OR IMPLIED, AS RELATED TO HEDIS VOLUME 2 OR INFORMATION THEREIN, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. 1407 0 obj <> endobj NCQA SHALL HAVE NO LIABILITY FOR ANY DAMAGES RESULTING FROM USE OR INTERPRETATION OF THE LICENSED MEASURE SPECIFICATIONS OR HEDIS VSD, INCLUDING BUT NOT LIMITED TO THE IMPACT, PROVISION OR STANDARD OF MEDICAL CARE, WHETHER OR NOT NCQA HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF).
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