0000038514 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. All notices to be given under this Agreement to Licensee shall be submitted by NCQA via e-mail at the account Licensee provided to NCQA. 0000002338 00000 n 0000009879 00000 n 0000106153 00000 n 0000310669 00000 n 0000037764 00000 n Sign up for or check out past quality improvement webinars on topics ranging from diabetes care to data submission. 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. 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. 0000043130 00000 n 0000042542 00000 n 0000308215 00000 n 0000042889 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. Has your contact information changed in the past two years? 0000029168 00000 n 0000092876 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. 0000007509 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. 0000031213 00000 n Refer to your state's guidance for payment details and telehealth regulations. What is HEDIS? 0000043682 00000 n 2022-2023 This guide provides HEDIS coding information only, not necessarily payment guidance. 0000027717 00000 n NCQA updated telehealth guidance in 40 HEDIS measures for HEDIS MYs 2020 and 2021. 0000043593 00000 n i09}}y P 5 0000042710 00000 n The following activities are expressly prohibited in connection with the use of HEDIS Volume 2 under this Agreement: 1. 0000033807 00000 n fz4cFb'98}1m'Gv{YMvEH_Wma}hn'a^`lwZwRis-^sQF6'[ZR)kH6fW=gpO'/ n &a)^y`_O~~$H67XIkxz}qk7^UXYlP!Fc#jxw!W(E_4CvF4DnL))Tz2R8./SiV5,hKkO(|Q_Y{IWYj&Yp\2/3%XhWtt0E{At5n6E'>loT%/$[s7 ]c9~G 0000020999 00000 n 1527 0 obj <>stream hXkTG/@$crvna%Ds]Tl 0000041544 00000 n 0000017945 00000 n 0000072229 00000 n 0000014342 00000 n 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. The HEDIS VSD is made available for customers that purchase a license for HEDIS Volume 2 from NCQA. 0000009453 00000 n No amendment, other modification or waiver of any term of this Agreement will be valid unless in writing signed by both parties. 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). 0000040496 00000 n View our FAQs. Optima Health 2023, 4417 Corporation Lane, Virginia Beach, VA 23462-3162. 2022. 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. THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF HEDIS VOLUME 2 IS WITH THE LICENSEE. We have a number of tools to help you boost HEDIS rates and increase your P4P award. 0000016645 00000 n For HEDIS related inquiries, please contact HEDIS_Ops@lacare.org. 0000042635 00000 n Submit this inquiry by logging intoMy NCQA, selecting theAsk a Questionbutton, then theOrdersbutton, then theCustom License Requestsoption. 0000012368 00000 n 0000064508 00000 n 0000106227 00000 n 0000041498 00000 n 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. 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. hb```B ce`aB-G_PG 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. 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). 0000037913 00000 n 0000008420 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. Unauthorized internal distribution of the publication and materials thereinbeyond the number of users licensed by your organizationis prohibited. 0000043549 00000 n 0000311459 00000 n Updates on HEDIS Measures MY2022 . 2127 87 0000041110 00000 n Documentation in a standardized prenatal flow sheet, or; b. 0000003513 00000 n 0000034689 00000 n 0000021645 00000 n 0000043770 00000 n 0000312102 00000 n ' f it4A@! 0000028427 00000 n <> Apr 1, 2022 Administrative. 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. 0000043989 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. %%EOF 0000023321 00000 n The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. For the best experience on our site, be sure to turn on Javascript in your browser. The License is not transferable from Licensee to any other person, entity, organization or association. 0000043182 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. 0000306886 00000 n The full HEDIS digital measure specifications are only available by purchasing a HEDIS digital measure product. 0000043265 00000 n IMPORTANT: Are you enrolled in Medi-Cal? 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. THE USE OF THE LICENSED MEASURE SPECIFICATIONS IS ENTIRELY AT LICENSEES OWN RISK AND NCQA SHALL HAVE NO LIABILITY OR RESPONSIBILITY THEREFOR. 0000040003 00000 n PRV 02.02.2022 . 0000311155 00000 n Helpful Hints 0000004105 00000 n Except where noted, the tip sheets include measure requirementsfor all our members including,all fully-insured PPO, Blue Choice PPOSMand HMO, Blue Cross Community Health PlansSM(BCCHPSM), Blue Cross Community MMAI (Medicare-Medicaid Plan)SMand Medicare Advantage members(unless otherwise specified). See how we support the vision of everyone having fair and just opportunities to be as healthy as possible. bfLZiPnBFAJ@9KN2kl>xnxX:+spU||)p?@enq-}\pyPRaex6W~)(Ix/]fFxP0 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. 0000037498 00000 n 0000004308 00000 n HEDIS Volume 2 contains proprietary and copyrighted information and notice to that effect must appear on all authorized copies of HEDIS Volume 2 (including the Licensed Measure Specifications) made by Licensee under this Agreement. 0000039528 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. xref View Table of Contents for this Publication. 0000093172 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). 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. 0000011027 00000 n 0000000016 00000 n 0000010484 00000 n 0000014362 00000 n Help your patients with redetermination. 0000011894 00000 n 0000015935 00000 n 1407 0 obj <> endobj 0000043353 00000 n 0000106009 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. 0000001516 00000 n HEDIS Volume 2 and the Licensed Measure Specifications expressly exclude all third-party code . 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. 2 0 obj 58 0 obj <> endobj xref 0000036645 00000 n SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES . 0000021318 00000 n HEDIS MY 2022, Volume 2 HEDIS VOLUME 2 MY 2022 . 11. 0000042375 00000 n 0000011157 00000 n 0000312745 00000 n 1171 0 obj <>stream 0000010465 00000 n 0000041171 00000 n JavaScript seems to be disabled in your browser. ?t5o7~ 2l7~w3o0B3rq /3}1l?Fc % Npttr}>'1*ePXQl6?WDCBc68:_14%p{}8Tbj XkN,KrfNi+o startxref 0000042754 00000 n 0000005121 00000 n Read more about the HEDIS schedule changehere. 0000009121 00000 n 0000015577 00000 n %PDF-1.6 % The obligations of both Parties shall not terminate upon any assignment or delegation attempted without such prior written consent. 0000036980 00000 n 0000043726 00000 n 0000018194 00000 n 0000010923 00000 n 0000007912 00000 n Height, weight, BMI percentile (use Z68.51-Z68.54) and nutrition (97802, 97803, 97804) and physical activity counseling (Z02.5, Z71.82) Lead Screening in Children: endobj The adjusted measure specification may be used only for internal quality improvement purposes. 0000041621 00000 n 0000005715 00000 n In addition, some sites may require you to agree to their terms of use and privacy policy. hb```b``e`c` @1v %M0-en{B)"p.1*'Y>Me}E;)2&u_hvO4Wu)4/Q%fV![\AE:-Trdc HEDIS MY2022. 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. 0000039591 00000 n HEDIS is the measurement tool used by the nation s health plans to evaluate their performance in terms of clinical quality and customer service. 0000312403 00000 n 0000010501 00000 n 0000009093 00000 n 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. 0000040140 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. 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. MEASUREDESCRIPTION OF MEASUREDOCUMENTATION TIPSCOMPLIANCE CODES & MEASURE TIPS Prevention and Screening Cervical Cancer Screening (CCS)* 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. Optima Preferred Provider Organization (PPO) products are issued and underwritten by Optima Health Insurance Company. The site may also contain non-Medicare related information. hbbd```b`` @$SdId:lZ ] DHV~'l g" 1D]3@{@Wn``W ! 0000033741 00000 n 0000306585 00000 n The National Committee for Quality Assurance (NCQA) developed the HEDIS measures. 0000006919 00000 n 0000033334 00000 n It is not intended to influence clinical and coding judgment. hUoKZ1Y8\..gM - Pu2&R;"pI3%8N`9ql(u[a3~pP. 0000004632 00000 n h1 04,n\GMyC. Documentation of LMP, EDD or gestational age, or rates. 0000010426 00000 n %%EOF 0000012711 00000 n 0000108933 00000 n NCQA has recommended 5 HEDIS measures be included beginning MY2022 with expectations to expand across a minimum of 15 measures by MY2024. 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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. 0000029610 00000 n 0000012365 00000 n Anyone desiring broader internal distribution of HEDIS Volume 2 must purchase additional Licensed User permissions via the NCQA Store. %%EOF 0 <<3742E41188BCC64D926D69F1B7DDE543>]/Prev 282268/XRefStm 4469>> 0000004603 00000 n 0000040903 00000 n hV PSW}I~B!i `!VDEeSpIQEF-@YBUDm_tw&s9 @@8 @L.i f,2e#/]DHVjI41;k!hM'% ALqnEyWyyrR}w05(Z2|D 0000012694 00000 n 0000010194 00000 n Unauthorized internal distribution of HEDIS Volume 2 and materials therein - beyond the number of Licensed Users by your organization - is prohibited. 0000135675 00000 n 0000042933 00000 n 0000004778 00000 n 0000310045 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). 0000010761 00000 n 0000003174 00000 n <]/Prev 525985/XRefStm 2956>> L.A. 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