0000043989 00000 n 1. 0000024421 00000 n 0000042754 00000 n Copyright 2023 National Committee for Quality Assurance. 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). The percentage of patients during the measurement year with schizophrenia or schizoaffective disorder who were dispensed and remained on an antipsychotic For HEDIS related inquiries, please contact HEDIS_Ops@lacare.org. stream 0000034181 00000 n %PDF-1.5 % WHEREAS, NCQA desires to provide Licensee with a license to use HEDIS Volume 2 in accordance with the terms of this Agreement. 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"). 0000307846 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. %%EOF trailer <<544F2374A80A4621986B17D4733DBC3A>]/Prev 388715>> startxref 0 %%EOF 118 0 obj <>stream 0000033339 00000 n 0000312918 00000 n 0000310217 00000 n or. %PDF-1.6 % Licensed Users mean Licensees employees who may access and use HEDIS Volume 2 on behalf of the Licensee. 0000040184 00000 n 0000109048 00000 n 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. Order educational materials for your patients. 0000011749 00000 n 0000307514 00000 n 0000007580 00000 n Controlling High Blood 18 - 85 yrs. 0000003432 00000 n NCQA is an independent, nonprofit organization. 0000311932 00000 n 0000040496 00000 n 0000033807 00000 n NCQA has separated the Comprehensive Diabetes indicators into stand-alone measures: 0000011383 00000 n 0000002081 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. Administrative Measure Quick Guide with Codes . 58 0 obj <> endobj xref 0000043130 00000 n 0000313465 00000 n 0000042092 00000 n 0000072229 00000 n xref 0000028427 00000 n An organizations licensed users may use the materials solely for an internal non-commercial purpose without obtaining NCQA approval. 0000028129 00000 n 0 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. 0000024026 00000 n Optima Health 2023, 4417 Corporation Lane, Virginia Beach, VA 23462-3162. 0000009862 00000 n 0000029485 00000 n Anyone desiring broader internal distribution of HEDIS Volume 2 must purchase additional Licensed User permissions via the NCQA Store. 0000004308 00000 n 0000308048 00000 n Read more about the HEDIS schedule changehere. 0000009238 00000 n 0000041331 00000 n 0000017054 00000 n It is not intended to influence clinical and coding judgment. 0000021645 00000 n 2 0 obj 0 0000005715 00000 n x\B+C8 ssVj'. Below is a summary of some of the key changes to be aware of: Diabetes measures. A dated graphic sheet . 0000042667 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. *i_k/ULV?v']+:9[VmCs>T1eANwI8e8`Fc1OK^As1(z}4==OQf*T",V/qq}%I XwsNL"~-u{UIppi/$&zh} 0000041621 00000 n 0000004718 00000 n fz4cFb'98}1m'Gv{YMvEH_Wma}hn'a^`lwZwRis-^sQF6'[ZR)kH6fW=gpO'/ n &a)^y`_O~~$H67XIkxz}qk7^UXYlP!Fc#jxw!W(E_4CvF4DnL))Tz2R8./SiV5,hKkO(|Q_Y{IWYj&Yp\2/3%XhWtt0E{At5n6E'>loT%/$[s7 ]c9~G 1171 0 obj <>stream 7 e># v3jDZE#VLFPq3O "{B hs` p$}$gi}3.a Q[TjX Hb)UF0 ]nX3"W`XLi"0Lkc@JeH,6dTj&RXeQP_R%M0z/lTY\>T`*-8Y{VH_1j-9l$U61u~ju\t'vQ4sZJ.QsKIhQv\!W0$lOGG%r2/8=q smB9cve5vsAnU36 E{(f4OL`NY65U%mfu x.fxEy:f,*&_%7cSaAzATC G'QNXpk:@8S. 0000042933 00000 n 0000022547 00000 n 0000037913 00000 n Has your contact information changed in the past two years? 0000108859 00000 n 0000041544 00000 n More than 90 percent of America's health plans use HEDIS to evaluate performance. 3 0 obj Commercial specifications should be followed for all required HEDIS 2022 and QARR 2022 NYS-specific measures. Sentara Health Plans, Inc. provides administrative services to group and individual health plans but does not underwrite benefits. 0000011157 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. External link You are leaving this website/app (site). 0000006599 00000 n 0000007396 00000 n Sign up for or check out past quality improvement webinars on topics ranging from diabetes care to data submission. hbbd```b`x"/I0yDHw`-R H2b;HWYH|&" 4H F ,{L `s?mm&F "3  We have a number of tools to help you boost HEDIS rates and increase your P4P award. 0000312403 00000 n 0000042208 00000 n 0000011225 00000 n 0000027717 00000 n 0000106122 00000 n Make sure your medical records reflect the following:-A note indicating a visit to PCP 0000016645 00000 n 2127 0 obj <> endobj 0000000016 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. 0000009376 00000 n Give your county office your updated contact information so you can stay enrolled. 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. 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. 0000309524 00000 n 0000042710 00000 n 0000311299 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. <> HEDIS is a nationally standardized set of measures related to important areas of care and service. 0000010761 00000 n 0000041066 00000 n 0000000016 00000 n 1111 61 0000307344 00000 n 0000002338 00000 n 0000041498 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. 0000009093 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. 0000310669 00000 n 0000313191 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. 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. Developed by the National Committee for Quality Assurance (NCQA), it is one of the most widely used set of health . 0000072352 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). 0000041110 00000 n 2127 87 View our frequently asked questions. H\n0E The adjusted measure specification may be used only for internal quality improvement purposes. Rate 1: Six or more well-child visits* 0 to 15 months. 0000313076 00000 n 0000040760 00000 n 0000007912 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 0000042055 00000 n The License is not transferable from Licensee to any other person, entity, organization or association. 1.833.LAC.DSNP (1-833-522-3767)(TTY 711)24 hours a day. 0000027069 00000 n 0000310375 00000 n 0000310995 00000 n 0000009879 00000 n 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. 0000011425 00000 n 0000043549 00000 n HEDIS MY 2022 Measures Applicable to: Commercial Medicaid Medicare Changes for HEDIS MY 2022 General Guidelines for Data Collection and Reporting endobj 0000109341 00000 n 0000032997 00000 n "R6!YV\#VAz\,E0Q{vrW7| 0000041375 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. 0000003478 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. LICENSEE IS RESPONSIBLE FOR PROCURING ALL EQUIPMENT AND SOFTWARE REQUIRED IN CONNECTION WITH THE USE OF HEDIS VOLUME 2. 0000044201 00000 n 0000003174 00000 n Licensee means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the Agreement terms below. 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. 0000002775 00000 n Use of the Marks shall inure to the benefit of NCQA. THE LIMITATIONS OF DAMAGES AND LIABILITIES SET FORTH IN THIS AGREEMENT ARE FUNDAMENTAL ELEMENTS OF THE BASIS OF THE BARGAIN BETWEEN NCQA AND LICENSEE. 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. 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. Prohibited Use AcknowledgementAn organizations Licensed Users may use HEDIS Volume 2 solely for a personal non-commercial purpose without obtaining NCQA approval. The following sections shall survive termination of this Agreement: Sections 2, 6, 7, 8, 9, 10, 11, 12 and 18. 0000006919 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. 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. 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. 0000023321 00000 n NCQA updated telehealth guidance in 40 HEDIS measures for HEDIS MYs 2020 and 2021. HEDIS MY2022. 0000033334 00000 n IMPORTANT: Are you enrolled in Medi-Cal? Billing Reference Sheets and Claims Submission and Guidelines, Pediatric Obesity Prevention and Treatment Toolkit. The clinical information provided is intended to aid in the understanding of HEDIS measures. 0000039802 00000 n 0000042542 00000 n !N8X efI~wh73Q>oVZ+ cmG!gV?ngR~7rUCZEOA`3t= pO] Vv 5wq26mxvBh. 1349 0 obj <> endobj 0000043052 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. HEDIS is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the health care quality. 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 What is HEDIS HEDIS rates are the most widely used set of health care performance measures on important preventive and clinical services. 0000013361 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. <]/Prev 961931/XRefStm 4105>> 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). 0000014342 00000 n 4 0 obj 0000042712 00000 n 0000108677 00000 n 1.2 Marks means the NCQA trademarks and/or service marks related to the Licensed Measure Specifications described in Section 5. trailer 0000108357 00000 n 0000040259 00000 n 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? 0000010787 00000 n 0000021658 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.

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