0000029168 00000 n 0000109048 00000 n Rate 2: Two additional well-child visits 15 to 30 months. 0000042889 00000 n 0000033357 00000 n WHEREAS, NCQA desires to provide Licensee with a license to use HEDIS Volume 2 in accordance with the terms of this Agreement. 0000310669 00000 n 0000012545 00000 n 0000041623 00000 n 0000036980 00000 n 0000108677 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. 0000072352 00000 n Read more about the HEDIS schedule changehere. 0000000016 00000 n 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. oaoNNg. Any use of HEDIS Volume 2 to identify records or calculate HEDIS measure results, for example, requires a custom license and may necessitate certification pursuant to NCQAs Measure Certification Program. Licensee agrees to defend, indemnify and hold harmless NCQA and its directors, officers, employees and agents from and against any and all liability, loss, cost, expense (including reasonable attorney fees), damage, or claim asserted by any third party alleged to arise out of or otherwise relate to Licensees use, reproduction, distribution, incorporation or display of the Third-Party Codes. 2022. 0000029274 00000 n Blue Cross and Blue Shield of Illinois (BCBSIL) reports audited Healthcare Effectiveness Data and Information Set (HEDIS) results. 0000009121 00000 n 0000043989 00000 n 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. Refer your patients for Health Education Services. 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. 0000043174 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. ?t5o7~ 2l7~w3o0B3rq /3}1l?Fc % Npttr}>'1*ePXQl6?WDCBc68:_14%p{}8Tbj XkN,KrfNi+o 0000038514 00000 n 0000042169 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. 0000009862 00000 n 0000044158 00000 n 0000042208 00000 n 0000012573 00000 n 0000007912 00000 n trailer The clinical information provided is intended to aid in the understanding of HEDIS measures. The site may also contain non-Medicare related information. 0000039575 00000 n This new site may be offered by a vendor or an independent third party. HEDIS Volume 2 and the Licensed Measure Specifications expressly exclude all third-party code . 0000004537 00000 n 0000042542 00000 n 0000001516 00000 n 1. 0000037990 00000 n 0000034564 00000 n 0000009093 00000 n 0000032997 00000 n Has your contact information changed in the past two years? <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 0000043265 00000 n 0000043549 00000 n 0000011303 00000 n 0000042933 00000 n 0000021024 00000 n 0000022782 00000 n x\B+C8 ssVj'. See how we support the vision of everyone having fair and just opportunities to be as healthy as possible. %PDF-1.5 % 0000017054 00000 n 0000034562 00000 n 0000039591 00000 n 0000007509 00000 n Anyone desiring broader internal distribution of HEDIS Volume 2 must purchase additional Licensed User permissions via the NCQA Store. 0000313465 00000 n HEDIS Volume 2 and the Licensed Measure Specifications expressly exclude all third-party code values contained in the HEDIS VSD which are owned, licensed or otherwise provided by third parties and protected under federal copyright laws (Third-Party Codes). 0000106153 00000 n What is HEDIS HEDIS rates are the most widely used set of health care performance measures on important preventive and clinical services. 0000043052 00000 n 0 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"). 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. ' f it4A@! 0000036645 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. 0000038593 00000 n 2022 MEDICAID HEDIS REFERENCE SHEET FOR PROVIDERS 3 PEDIATRIC HEDIS MEASURES HEDIS MEASURE AGE MEASURE DESCRIPTION BILLING CODES WELL-VISIT Well Child Visits 0-30 Months of Life (W30) 0-30 months Telehealth exclusion removed. Anyone desiring broader internal distribution of HEDIS Volume 2 must purchase additional licensed user permissions via the NCQA Store. 0000033334 00000 n 0000309690 00000 n 58 61 0000106122 00000 n 0000017945 00000 n 0000042754 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. 0000010501 00000 n 0000032765 00000 n 0000040859 00000 n 0000000016 00000 n All other uses, including a commercial use (including but not limited to vendors using or embedding the measures and specifications and/or HEDIS VSD into any product or service to calculate measure results for customers for any purpose) and/or any 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. hbbd```b`x"/I0yDHw`-R H2b;HWYH|&" 4H F ,{L `s?mm&F "3  hV PSW}I~B!i `!VDEeSpIQEF-@YBUDm_tw&s9 @@8 @L.i f,2e#/]DHVjI41;k!hM'% ALqnEyWyyrR}w05(Z2|D HEDIS MY 2022, Volume 2 HEDIS VOLUME 2 MY 2022 . HEDIS is the measurement tool used by the nation s health plans to evaluate their performance in terms of clinical quality and customer service. 0000003513 00000 n 0000307212 00000 n 0000042667 00000 n %%EOF 0000043397 00000 n JavaScript seems to be disabled in your browser. As a part of L. A. Cares 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. 0000309151 00000 n If a required measure has only Medicaid specifications, commercial organizations 1349 0 obj <> endobj 1.2 Marks means the NCQA trademarks and/or service marks related to the Licensed Measure Specifications described in Section 5. TO THE MAXIMUM EXTENT ALLOWABLE BY LAW, THE PARTIES DISCLAIM THE APPLICABILITY OF THE UNIFORM COMMERCIAL CODE OR OTHER UNIFORM LAWS. :u_qnDRXlg3ULQMEK:`tYme%4ot FbzX/t1&?(S3E,kmdoi'f3`]:XFQM8.?OJH49n0!+oj8)3QX&(WAa8\ ew[-|sHI&-](H$X :q3sK.9!1TQnv?5 }jdD9% .@>vSBkL-:\8Cf5*26 k~hr^=Ll i_5Ch'oY4[ 5* 0000042130 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. 0000093172 00000 n 0000010580 00000 n 0000039528 00000 n 0000040540 00000 n 0000311155 00000 n NEITHER PARTY SHALL HAVE ANY LIABILITY FOR ANY INCIDENTAL, SPECIAL, CONSEQUENTIAL OR OTHER INDIRECT DAMAGES ARISING UNDER OR RELATED TO THIS AGREEMENT, WHETHER OR NOT THE PARTY HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. Any breach of this Agreement 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. 0000006654 00000 n Read this Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. 0000043770 00000 n 0000002209 00000 n Health Net - Coverage for Every Stage of Life | Health Net 0000001550 00000 n A list of potential measures for initial stratification in MY2022 are as follows: Controlling High Blood Pressure (CBP) Comprehensive Diabetes Care (CDC) Antidepressant Medication Management (AMM) 2127 87 0000307344 00000 n 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 An organizations licensed users may use the materials solely for an internal non-commercial purpose without obtaining NCQA approval. 0000009879 00000 n Apr 1, 2022 Administrative. 0000010020 00000 n 0000007623 00000 n 0000010194 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. vtt4LJ0G4v@uE %%aP=PKhXZ`ZZZF&m sq/P"]@ i09}}y P 5 2020 HEDIS Cheat Sheet Measure HEDIS Requirement Rendering Provider Needs to report W34 Well Child visits in ages 3-6 years of life Measures percentage of members 3 to 6 years of age who had one or more comprehensive well child visits with a PCP during the year. 0000037381 00000 n 0000042710 00000 n *i_k/ULV?v']+:9[VmCs>T1eANwI8e8`Fc1OK^As1(z}4==OQf*T",V/qq}%I XwsNL"~-u{UIppi/$&zh} 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. 0000002081 00000 n 0000004580 00000 n Telehealth encounters in . THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF HEDIS VOLUME 2 IS WITH THE LICENSEE. 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. Compliance with these measures may reduce the need for you to send medical records later for review. To DECLINE this Agreement, do not proceed and contact my.ncqa.org with any questions or concerns or request for a custom license agreement to meet your needs. 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). 0000310995 00000 n 0000034332 00000 n 0000308347 00000 n 0000032947 00000 n For HEDIS related inquiries, please contact [email protected]. 0000041066 00000 n 0000042635 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. More than 90 percent of America's health plans use HEDIS to evaluate performance. 2022. with: Progress note with latest blood pressure reading taken in . 0000013020 00000 n Submit this inquiry by logging intoMy NCQA, selecting theAsk a Questionbutton, then theOrdersbutton, then theCustom License Requestsoption. 0000042092 00000 n Rate 1: Six or more well-child visits* 0 to 15 months. %%EOF %%EOF THE LIMITATIONS OF DAMAGES AND LIABILITIES SET FORTH IN THIS AGREEMENT ARE FUNDAMENTAL ELEMENTS OF THE BASIS OF THE BARGAIN BETWEEN NCQA AND LICENSEE. 0000034483 00000 n We have a number of tools to help you boost HEDIS rates and increase your P4P award. A Licensed User may not be an agent or consultant of a Licensee. 0000012813 00000 n 0000013361 00000 n 0000026677 00000 n 0000311459 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. Give your county office your updated contact information so you can stay enrolled. 0000011383 00000 n 0000013091 00000 n hb```b``e`c` @1v %M0-en{B)"p.1*'Y>Me}E;)2&u_hvO4Wu)4/Q%fV![\AE:-Trdc 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). or. 0000028129 00000 n 0000002956 00000 n 0000004280 00000 n HEDIS Measure Guidelines for Behavioral Health Providers Adults' Access to Preventive/Ambulatory Health Services (AAP) Advanced Care Planning (ACP) Breast Cancer Screening (BCS-E) Depression Remission or Response for Adolescents and Adults (DRR-E) Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC)

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