All other uses, including a commercial use (including but not limited to vendors or consultants using or embedding the measures and specifications and/or HEDIS VSD 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 obligations of both Parties shall not terminate upon any assignment or delegation attempted without such prior written consent. 0000108933 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). 0000307683 00000 n 1. or. NCQA warrants that the media on which HEDIS Volume 2 is furnished will be free of defects in materials and workmanship under normal use for a period of ninety (90) days from the date of purchase. startxref 0000106009 00000 n 0000033702 00000 n trailer 0000040003 00000 n Licensee means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the Agreement terms below. 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). 0000106227 00000 n 0000312555 00000 n 0000038453 00000 n 0000040760 00000 n 0000010020 00000 n 0000040540 00000 n 0000306585 00000 n View our FAQs. HEDIS MY 2022 . x\B+C8 ssVj'. 0000004508 00000 n 0000010580 00000 n As a result, HEDIS is the ultimate measurable tool to evaluate provider's performance and quality of care. The site may also contain non-Medicare related information. 2022. 0000043593 00000 n 0000001516 00000 n 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. 0000002956 00000 n 0000036980 00000 n 0000012962 00000 n 0000034814 00000 n 0000032558 00000 n To verify compliance with this Agreement, NCQA is granted the right, with prior notice and during normal business hours, to examine all relevant records of Licensee. 0000043902 00000 n 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. 0000004632 00000 n HEDIS MY2022. If a required measure has only Medicaid specifications, commercial organizations 0000022901 00000 n B,2I#QayB\*@. 0000034332 00000 n 0000308649 00000 n HEDIS MY 2022 Measures Applicable to: Commercial Medicaid Medicare Changes for HEDIS MY 2022 General Guidelines for Data Collection and Reporting Refer your patients for Health Education Services. 0000309524 00000 n 0000036108 00000 n 0000029610 00000 n 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. 1527 0 obj <>stream Sole ownership rights to the Licensed Measure Specifications and any modifications, alterations or adjustments thereof reside with NCQA. 0000014908 00000 n 0000011157 00000 n PRV 02.02.2022 . 0000012711 00000 n 0000009093 00000 n In the event NCQA receives notification within the warranty period of any defects in the media, NCQA will, at its option, either replace such defective media or return to Licensee the price paid for HEDIS Volume 2. <> 0000033334 00000 n HEDIS (Healthcare Effectiveness Data and Information Set) is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) to objectively measure, report, and compare quality across health plans. Compliance with these measures may reduce the need for you to send medical records later for review. 0000015921 00000 n NCQA has separated the Comprehensive Diabetes indicators into stand-alone measures: 0000011830 00000 n Follow HEDIS 2022 instructions regarding commercial POS products. 0000012365 00000 n 0000040601 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). %PDF-1.7 % 0000008197 00000 n 0000043472 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). 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. Go to benefitscal.com or call the Los Angeles County Department of Public Social Services at 1-866-613-3777. 0000004537 00000 n Rate 1: Six or more well-child visits* 0 to 15 months. 8259 0 obj <> endobj Compliance with these measures may reduce the need for you to send medical records later for review. HL7 is the registered trademark of Health Level Seven International. 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 Documentation of LMP, EDD or gestational age, or 0000042498 00000 n 0000042169 00000 n Quality measures help ensure our members receive appropriate care. 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. 0000312918 00000 n 0000093172 00000 n NCQA and Licensee may be individually referred to as a Party, or collective, the Parties. 0000014698 00000 n 0000041621 00000 n Relevant records as used in this paragraph shall include all computer systems; software products; and print and electronic books and records. Unauthorized internal distribution of HEDIS Volume 2 and materials therein - beyond the number of Licensed Users by your organization - is prohibited. Updates on HEDIS Measures MY2022 . <]/Prev 961931/XRefStm 4105>> 0000312403 00000 n 0000037577 00000 n 0000021658 00000 n 0000033741 00000 n Have questions about renewing your Medi-Cal? HEDIS/CAHPS Measures Required for HP AccreditationCommercial *The weight column indicates the weight of the item (maximum value = 3) in the overall score calculation. Read this Agreement carefully before indicating acceptance by clicking the associated checkbox/button and moving forward. trailer 0000043130 00000 n 1171 0 obj <>stream 0000042933 00000 n endstream endobj 1350 0 obj <. 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. Health Net - Coverage for Every Stage of Life | Health Net 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. 0000033255 00000 n 0000005859 00000 n 0000010923 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. 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. 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. 0000031901 00000 n 0000003478 00000 n HEDIS Volume 2 is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. %%EOF Use of the Marks shall inure to the benefit of NCQA. Has your contact information changed in the past two years? 0000004308 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. The following sections shall survive termination of this Agreement: Sections 2, 6, 7, 8, 9, 10, 11, 12 and 18. Upon termination of this Agreement, all rights under this Agreement, including the License, will cease. 0000004580 00000 n Below is a summary of some of the key changes to be aware of: Diabetes measures. trailer <<544F2374A80A4621986B17D4733DBC3A>]/Prev 388715>> startxref 0 %%EOF 118 0 obj <>stream 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? %PDF-1.6 % 0000033138 00000 n This information sheet is accurate as of the date it is published but may change as HEDIS measures are updated or based on other factors. 0000011140 00000 n T i09}}y P 5 [ 0000040903 00000 n oaoNNg. 0000014342 00000 n 0000010501 00000 n 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. 3 0 obj L.A. Care Health Plan representatives are available 24 hours a day, 7 days a week, including holidays to help you. 0000010484 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. 0000015577 00000 n 0000043858 00000 n 0000043353 00000 n 0000042208 00000 n Refer to your state's guidance for payment details and telehealth regulations. 0000009834 00000 n 0000072352 00000 n 0000033357 00000 n 0000043726 00000 n 0000039802 00000 n 0000033025 00000 n HEDIS Measures A quick and easy reference containing the most current information, measure descriptions, and tips to help improve rates of compliance. What is HEDIS HEDIS rates are the most widely used set of health care performance measures on important preventive and clinical services. 0000018194 00000 n <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 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. 0000042661 00000 n Any The clinical information provided is intended to aid in the understanding of HEDIS measures. 0 A quick and easy reference containing the most current information, measure descriptions, and tips to help improve rates of compliance. 0000003432 00000 n 0000022547 00000 n H\n0E 0000034181 00000 n 0000006654 00000 n %PDF-1.6 % 0000002775 00000 n 0000004778 00000 n 0000043770 00000 n The HEDIS VSD is made available for customers that purchase a license for HEDIS Volume 2 from NCQA. Rate 2: Two additional well-child visits 15 to 30 months. 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"). 0000007912 00000 n Licensee agrees to maintain HEDIS Volume 2 in strict confidence and abide by all terms and conditions of this Agreement. h1 04,n\GMyC. ?t5o7~ 2l7~w3o0B3rq /3}1l?Fc % Npttr}>'1*ePXQl6?WDCBc68:_14%p{}8Tbj XkN,KrfNi+o 0000307059 00000 n qJ{*ay|UgxEjM&aMzw- hR ZMr 5TW[Q2\Cbyh|#my\?Qj**}g}F 0000009376 00000 n 0000309339 00000 n 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 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. 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. A dated graphic sheet . 0000029274 00000 n 58 61 0000000016 00000 n Controlling High Blood 18 - 85 yrs. 0000008785 00000 n 0000043814 00000 n 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. %PDF-1.6 % One option is Adobe Reader which has a built-in reader. %PDF-1.5 % endstream endobj startxref cytology performed between 2020-2022. startxref 0000009862 00000 n endobj 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. Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, and Sentara Health Plans, Inc. Optima Health Maintenance Organization (HMO) products, and Point-of-Service (POS) products, are issued and underwritten by Optima Health Plan. 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) 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. 8314 0 obj <>stream 0000011425 00000 n The following activities are expressly prohibited in connection with the use of HEDIS Volume 2 under this Agreement: 1. 0000309871 00000 n ' f it4A@! The License is limited subject to the following terms and conditions. Order educational materials for your patients. 0000004105 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. HEDIS is a nationally standardized set of measures related to important areas of care and service. Billing Reference Sheets and Claims Submission and Guidelines, Pediatric Obesity Prevention and Treatment Toolkit. PREVENTION AND SCREENING Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Breast Cancer Screening Colorectal Cancer Screening Care for Older Adults RESPIRATORY 0000037764 00000 n 0000005715 00000 n LICENSEE IS RESPONSIBLE FOR PROCURING ALL EQUIPMENT AND SOFTWARE REQUIRED IN CONNECTION WITH THE USE OF HEDIS VOLUME 2. 0000041331 00000 n 0000011894 00000 n 1111 61 0000043182 00000 n 0000041082 00000 n 0000023321 00000 n 0000006410 00000 n 0000044158 00000 n For HEDIS related inquiries, please contact HEDIS_Ops@lacare.org. It is not intended to influence clinical and coding judgment. X]E| iR*W1Fr!r"n,+K9*"-XjV=Q[OL]jPz[#5i#r?lBwEEa^ZcP"m)L=)/H!?>o[roJZ On*jdY>6P`ww]Kk|z{:G2B940x./?cq8L. In effectuating its obligations hereunder, the 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. 0000002081 00000 n This new site may be offered by a vendor or an independent third party. 0000039591 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. 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. 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. 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. 0000310217 00000 n 0000072229 00000 n 0000016961 00000 n 0000310823 00000 n 0000018305 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.
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