Below is a summary of some of the key changes to be aware of: Diabetes measures. 0000016662 00000 n 0000043770 00000 n 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. 0000019994 00000 n 0000034562 00000 n New HEDIS Measures for MY 2023 HEDIS Measure Descriptions Frequently Asked Questions CLINICAL REFERENCE Avoidance of Antibiotic Use Clinical Guidelines HEDIS Measures Immunization Schedules <>/Metadata 6463 0 R/ViewerPreferences 6464 0 R>> 0000010465 00000 n Optima Health 2023, 4417 Corporation Lane, Virginia Beach, VA 23462-3162. 0000012813 00000 n 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. Controlling High Blood 18 - 85 yrs. endobj Adults' Access to Preventive/Ambulatory Health Services (AAP) Description; Assesses the percentage of members 20 years and older who had an ambulatory or preventive care visit during the measurement year . A quick and easy reference containing the most current information, measure descriptions, and tips to help improve rates of compliance. 0000007623 00000 n 0000043549 00000 n Anyone contemplating a commercial use, or external reproduction, distribution or publication of any part of Volume 2, should not purchase HEDIS Volume 2 via the NCQA Store, and must contact the NCQA licensing teamto discuss the need for a license. B,2I#QayB\*@. 0000005121 00000 n 0000112852 00000 n 0000307059 00000 n 0000043182 00000 n 1.833.LAC.DSNP (1-833-522-3767)(TTY 711)24 hours a day. Have you tried MyHIM, our member wellness program? 0000015935 00000 n 0000306585 00000 n endstream endobj startxref <]/Prev 525985/XRefStm 2956>> One option is Adobe Reader which has a built-in reader. 0000010020 00000 n Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment. 0000033926 00000 n 0000312918 00000 n 0000000016 00000 n qJ{*ay|UgxEjM&aMzw- hR ZMr 5TW[Q2\Cbyh|#my\?Qj**}g}F 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. 0000043902 00000 n 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. startxref 0000012962 00000 n H\n0E 2213 0 obj <>stream Also, Licensee must prominently display the following notice near each adjusted Licensed Measure Specification using the Rules, or display as a footnote on each page in which an adjustment Licensed Measure Specification exists: The NCQA HEDIS measure specification has been adjusted pursuant to NCQAs Rules for Allowable Adjustments of HEDIS. Failure to insist on strict performance of any term of this Agreement will not operate as a waiver of any subsequent default or failure of performance. 58 61 The License is limited subject to the following terms and conditions. 0000040337 00000 n hbbd```b`x"/I0yDHw`-R H2b;HWYH|&" 4H F ,{L `s?mm&F "3  0000023670 00000 n 0000012426 00000 n 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. endstream endobj startxref The full HEDIS digital measure specifications are only available by purchasing a HEDIS digital measure product. 0000106048 00000 n 0000011383 00000 n 0000308812 00000 n 0000135675 00000 n A required resource for anyone involved in collecting, calculating or submitting HEDIS data, HEDIS MY 2022 Volume 2 features the complete technical specifications for each measure. 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). 0000033702 00000 n %%EOF 0000311932 00000 n Billing Reference Sheets and Claims Submission and Guidelines, Pediatric Obesity Prevention and Treatment Toolkit. Updates on HEDIS Measures MY2022 . 0000032997 00000 n <<3742E41188BCC64D926D69F1B7DDE543>]/Prev 282268/XRefStm 4469>> 0000310045 00000 n , II 0000306648 00000 n %PDF-1.6 % Unauthorized internal distribution of HEDIS Volume 2 and materials therein - beyond the number of Licensed Users by your organization - is prohibited. 0000043682 00000 n 0000009453 00000 n 0 This Agreement represents the complete agreement between the Parties concerning its subject matter and shall supersede all other agreements, whether written or oral, with respect to such subject matter, other than any nondisclosure or similar agreement, which shall remain in full force and effect. 0000311299 00000 n 0 MEASUREDESCRIPTION OF MEASUREDOCUMENTATION TIPSCOMPLIANCE CODES & MEASURE TIPS Prevention and Screening Cervical Cancer Screening (CCS)* 0000004105 00000 n HEDISThe Healthcare Effectiveness Data and Information Set (HEDIS) is a registered trademark of NCQA. 0000040859 00000 n 0000019374 00000 n 0000012285 00000 n 0000032123 00000 n Anyone desiring broader internal distribution of HEDIS Volume 2 must purchase additional licensed user permissions via the NCQA Store. 0000039575 00000 n 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 HEDIS Volume 2. In January to May of 2023, data for 2022 continues to be submitted along with Medical Record review for Hybrid measures and final HEDIS 2022 rates and results are reported. Order educational materials for your patients. 0000010194 00000 n 0000038002 00000 n 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. 0000010923 00000 n 0000017908 00000 n 0000032765 00000 n THE LIABILITY OF EITHER PARTY TO THE OTHER PARTY ARISING UNDER THIS AGREEMENT WHETHER IN CONTRACT, TORT, OR OTHERWISE SHALL BE LIMITED TO ACTUAL AND DIRECT DAMAGES. o,;6iN?e/.y)>2-@%!H20C@eW D* G^ %PDF-1.7 % <> startxref 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. 0000006410 00000 n 0000307683 00000 n 0000041786 00000 n 0000072352 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 agrees to maintain HEDIS Volume 2 in strict confidence and abide by all terms and conditions of this Agreement. 0000011303 00000 n 0000000016 00000 n 0000106009 00000 n WHEREAS, NCQA desires to provide Licensee with a license to use HEDIS Volume 2 in accordance with the terms of this Agreement. 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. / 0000003432 00000 n Submit this inquiry by logging intoMy NCQA, selecting theAsk a Questionbutton, then theOrdersbutton, then theCustom License Requestsoption. %PDF-1.6 % HEDIS Volume 2 is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. Licensee shall indemnify and hold harmless NCQA and its directors, officers and employees from and against any and all liability, loss, cost, expense (including reasonable attorney fees), damage, or claim (Losses), including any Losses asserted by third parties, in proportion to, and to the extent the Losses arise from / or relate to the Licensees breach of this Agreement. 0000000016 00000 n 0000310525 00000 n 0000038514 00000 n 0000106227 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. NCQA MAKES NO WARRANTY, EXPRESS OR IMPLIED, WITH RESPECT TO THE LICENSED MEASURE SPECIFICATIONS OR ANY OTHER INFORMATION OR MATERIALS DELIVERED PURSUANT TO THIS AGREEMENT, INCLUDING WITHOUT LIMITATION ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE, AND NCQA DISCLAIMS AND MAKES NO WARRANTY OR REPRESENTATIONS AS TO THE ACCURACY, QUALITY, RELIABILITY, SUITABILITY, COMPLETENESS, TRUTHFULNESS, USEFULNESS, OR EFFECTIVENESS OF THE LICENSED MEASURE SPECIFICATIONS. 0000032166 00000 n Read this Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. 0000018194 00000 n 0000008197 00000 n 0000015921 00000 n 0000034181 00000 n 0000311155 00000 n 0000008420 00000 n %%EOF No amendment, other modification or waiver of any term of this Agreement will be valid unless in writing signed by both parties. 0000036980 00000 n 0000021318 00000 n xn0#eR;TUj!@iFQ;6t$-h4Lblp|FC''p6@b^{|K@i&!MBot&ji`Wix P)V(K+Yn*g^\(5%ha startxref 0 0000040601 00000 n No individual or entity may use HEDIS Volume 2 to evaluate another organization against NCQA standards, except as part of Licensees internal preparation for an NCQA survey or review.2. THE LIMITATIONS OF DAMAGES AND LIABILITIES SET FORTH IN THIS AGREEMENT ARE FUNDAMENTAL ELEMENTS OF THE BASIS OF THE BARGAIN BETWEEN NCQA AND LICENSEE. Documentation in a standardized prenatal flow sheet, or; b. As a part of L. A. Care's initiative to improve quality of care to our members, these HEDIS (Healthcare Effectiveness Data and Information Set) reference guides for selected priority HEDIS measures are designed to help your practice provide the best quality care, in alignment with the HEDIS standards as well as with evidence-based clinical practice guidelines. 0000038453 00000 n 0000042542 00000 n Refer to your state's guidance for payment details and telehealth regulations. For example, 2022 claims, encounters, and other HEDIS data are submitted throughout 2022. L.A. Care is proud to participate in Covered California to offer affordable health insurance to Los Angeles County residents. 0 0000033741 00000 n NCQAs name and logo, and all other names, logos, icons, trademarks, and/or service marks identifying NCQA and its programs, product(s) and services are proprietary trademarks of NCQA and any use not expressly provided for in this Agreement is strictly prohibited. 0000013091 00000 n All questions, comments or notices concerning this Agreement shall be submitted to NCQA by Licensee via email at my.NCQA.org or via mail at NCQA, Attention: Information Products, 1100 13th Street NW, Third Floor, Washington, DC 20005. 0000007912 00000 n stream 0000310217 00000 n BP taken and reported by member using . 0000013020 00000 n 0000021024 00000 n Title to and full ownership of the Licensed Measure Specifications (and adjustments thereto) and all intellectual property rights therein (including, but not limited to, all copyrights, patent rights, and trade secret rights) belong to NCQA or NCQA has obtained the necessary rights in the Licensed Measure Specifications (except as otherwise set forth regarding third party copyright ownership of portions of the HEDIS VSD) to grant the rights and licenses set forth herein. 0000309871 00000 n 0000040903 00000 n 0000016961 00000 n It also includes general guidelines for data collection and reporting, detailed instructions about how to perform the necessary calculations and guidelines for sampling. 0000037913 00000 n View our frequently asked questions. bfLZiPnBFAJ@9KN2kl>xnxX:+spU||)p?@enq-}\pyPRaex6W~)(Ix/]fFxP0 0000031213 00000 n 0000034483 00000 n 0000014362 00000 n 0000010501 00000 n The obligations of both Parties shall not terminate upon any assignment or delegation attempted without such prior written consent. 0000309151 00000 n 0000312403 00000 n !N8X efI~wh73Q>oVZ+ cmG!gV?ngR~7rUCZEOA`3t= pO] Vv 5wq26mxvBh. 0000004603 00000 n Anyone desiring broader internal distribution of HEDIS Volume 2 must purchase additional Licensed User permissions via the NCQA Store. 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). 0000009862 00000 n AWARE- California Medical Association Foundation: Physician Resources, HEDIS MY 2023 Hybrid Measure Quick Guide with Codes, HEDIS MY 2023 Hybrid Measure Pocket Guide, HEDIS MY 2023 Administrative Measure Quick Guide with Codes, HEDIS MY 2023 Chart Submission Requirements, QI Interventions Reported by Top Performing IPAs, How to access Provider Opportunity/Gaps in Care Reports, HEDIS Tip Sheet: Timeliness of Prenatal Care, Preventive Care Documentation Flyers for Providers, Timely Access to Care Suggested Interventions for IPAs, Timely Access to Care Oversight & Monitoring PPG Training, Timely Access to Care Oversight & Monitoring FAQ, Slide Deck: Moving the Needle on Member Satisfaction. Most PDF readers are a free download. 0000002209 00000 n NOW, THEREFORE, for good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows: 1.1 Licensed Measure Specifications shall mean NCQAs 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. 0000033357 00000 n 0000311633 00000 n 0000004469 00000 n trailer 0000009238 00000 n Helpful Hints 0000042635 00000 n If a required measure has only Medicaid specifications, commercial organizations 0000037498 00000 n 58 0 obj <> endobj xref 2 0 obj 0000039848 00000 n oaoNNg. 0000024026 00000 n 0000013361 00000 n 0000037613 00000 n Women 30-64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed between 2018-2022. . 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{ PRV 02.02.2022 . 0000029379 00000 n 0000003478 00000 n hV PSW}I~B!i `!VDEeSpIQEF-@YBUDm_tw&s9 @@8 @L.i f,2e#/]DHVjI41;k!hM'% ALqnEyWyyrR}w05(Z2|D The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. 0000042977 00000 n 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. 0000306723 00000 n 0000038593 00000 n Administrative Measure Quick Guide with Codes . endstream endobj 2212 0 obj <>/Filter/FlateDecode/Index[119 2008]/Length 63/Size 2127/Type/XRef/W[1 1 1]>>stream 0000309524 00000 n For HEDIS related inquiries, please contact HEDIS_Ops@lacare.org. 1371 0 obj <>/Filter/FlateDecode/ID[<7F9DDD8800BFEE4C9404AE52E016A647><02E18FF8926EFD40AEA58E0129A180D3>]/Index[1349 36]/Info 1348 0 R/Length 110/Prev 309529/Root 1350 0 R/Size 1385/Type/XRef/W[1 3 1]>>stream 0000044076 00000 n 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. 0000042667 00000 n 0000033025 00000 n [ 0000009879 00000 n 0000043397 00000 n 0000028129 00000 n 0000311784 00000 n 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. 0000033138 00000 n 0000005173 00000 n 0000041171 00000 n Sentara Health Plans, Inc. provides administrative services to group and individual health plans but does not underwrite benefits. 0000004308 00000 n HEDIS Measures A quick and easy reference containing the most current information, measure descriptions, and tips to help improve rates of compliance. THE USE OF THE LICENSED MEASURE SPECIFICATIONS IS ENTIRELY AT LICENSEES OWN RISK AND NCQA SHALL HAVE NO LIABILITY OR RESPONSIBILITY THEREFOR. 0000004537 00000 n 0000006884 00000 n 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). 0000042169 00000 n 0000013099 00000 n In addition, some sites may require you to agree to their terms of use and privacy policy. Organizations that need help determining how their use of NCQAs HEDIS measure specifications and Value Set Directories fit into NCQAs licensing and certification requirements should use theHEDIS Licensing Tool. 4 0 obj 0000313191 00000 n 0000042712 00000 n 0000042208 00000 n To ACCEPT this Agreement, click the accompanying checkbox/button to accept the terms of this product, which will create a legal contract that will bind Licensee and NCQA. 0000009376 00000 n BECAUSE SOME STATES OR JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY FOR DAMAGES, THE ABOVE LIMITATIONS MAY NOT APPLY TO LICENSEE. 0000038081 00000 n 0000312251 00000 n HEDIS is the gold standard in health care performance measurement, used by more than 90 percent of the nation's health plans and many leading employers and regulators. 0000002081 00000 n 0000032558 00000 n 0000043989 00000 n Have questions about renewing your Medi-Cal? Developed by the National Committee for Quality Assurance (NCQA), it is one of the most widely used set of health .
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