Compliance with these measures may reduce the need for you to send medical records later for review. endstream endobj 1350 0 obj <. 0000033081 00000 n 0000021024 00000 n 0000023321 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. 0000005173 00000 n Below is a summary of some of the key changes to be aware of: Diabetes measures. Individual HEDIS Measures Sheets | Providers | Optima Health PDF HEDIS MY 2022 - L.A. Care Health Plan HEDIS MY 2022, Volume 2 HEDIS VOLUME 2 MY 2022 . IMPORTANT: Are you enrolled in Medi-Cal? 0000034562 00000 n 0000011383 00000 n In addition, some sites may require you to agree to their terms of use and privacy policy. 0000037913 00000 n 0000310823 00000 n 0000022782 00000 n 0000312102 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. 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? 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. HEDISThe Healthcare Effectiveness Data and Information Set (HEDIS) is a registered trademark of NCQA. 0000027717 00000 n 0000040601 00000 n 0000307514 00000 n 0000028427 00000 n 11. 0000021322 00000 n 0000024421 00000 n Optima Preferred Provider Organization (PPO) products are issued and underwritten by Optima Health Insurance Company. 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. NCQA updated telehealth guidance in 40 HEDIS measures for HEDIS MYs 2020 and 2021. 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. 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). 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. 0000005715 00000 n 0000311784 00000 n %PDF-1.6 % Unauthorized internal distribution of the publication and materials thereinbeyond the number of users licensed by your organizationis prohibited. 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. 0000042331 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. 0000000016 00000 n T If a required measure has only Medicaid specifications, commercial organizations 0000013020 00000 n HEDIS Measurements - Aetna 0000312251 00000 n h_HSQ]B,7=$,h5%A9(4zoIdXYT 0000042498 00000 n 0000032166 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) View Table of Contents for this Publication. Sentara Health Plans, Inc. provides administrative services to group and individual health plans but does not underwrite benefits. 0000038081 00000 n Billing Reference Sheets and Claims Submission and Guidelines, Pediatric Obesity Prevention and Treatment Toolkit. 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. Noncompliance may also disqualify Licensee from receiving future goods and services from NCQA. New HEDIS Measures for MY 2023 HEDIS Measure Descriptions Frequently Asked Questions CLINICAL REFERENCE Avoidance of Antibiotic Use Clinical Guidelines HEDIS Measures Immunization Schedules Helpful Hints 0000021658 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. The report cards use a standard set of measures called the Healthcare Effectiveness Data and Information Set (HEDIS ).*. 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. 0000308812 00000 n hbbd```b`x"/I0yDHw`-R H2b;HWYH|&" 4H F ,{L `s?mm&F "3 0000015577 00000 n 0000032997 00000 n 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. 0000019655 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. 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. 0000040496 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. 0000039096 00000 n 0000092606 00000 n 0000012711 00000 n endstream endobj 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. PDF HEDIS VOLUME 2 MY 2022 - National Committee for Quality Assurance 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. View our FAQs. 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. 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: 0000029610 00000 n Relevant records as used in this paragraph shall include all computer systems; software products; and print and electronic books and records. 0000310995 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. NCQA may terminate this Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. startxref [ PDF HEDIS 2022 Manual - Johns Hopkins Medicine 0000043052 00000 n :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* 0000034181 00000 n The section headings contained in this Agreement are included for reference only and shall not affect the construction or interpretation of any term in this Agreement. HEDIS is the measurement tool used by the nation s health plans to evaluate their performance in terms of clinical quality and customer service. 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. PDF 2020 HEDIS Cheat Sheet - irp-cdn.multiscreensite.com Order educational materials for your patients. It also includes general guidelines for data collection and reporting, detailed instructions about how to perform the necessary calculations and guidelines for sampling. 0000040760 00000 n 0000034689 00000 n 0000032765 00000 n This Agreement is deemed to be made under and shall be interpreted in accordance with the laws of the District of Columbia, without regard to its conflict of law principles. 0000044201 00000 n 0000310045 00000 n 0000043902 00000 n 2213 0 obj <>stream 0000009862 00000 n 2127 0 obj <> endobj %%EOF 0000033339 00000 n 0000042977 00000 n 0000311459 00000 n 0000009453 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. 0000042712 00000 n 0000019994 00000 n These Third-Party Codes may be protected under federal copyright laws and are included in HEDIS Volume 2 with the permission of the copyright owners. ' f it4A@! HEDIS Volume 2 and the Licensed Measure Specifications expressly exclude all third-party code . % HEDIS Measures and Technical Resources - NCQA HEDIS MY2022. 0000027069 00000 n 0000039666 00000 n 0000009879 00000 n 0000008420 00000 n 0000052324 00000 n 0000024026 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. 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). PDF Hedis Cheat Sheet 2022 - 2023 THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF HEDIS VOLUME 2 IS WITH THE LICENSEE. 0000042667 00000 n More than 90 percent of America's health plans use HEDIS to evaluate performance. PDF 2022 Hedis (Measurement Year) Medicaid Reference Sheet Compliance with these measures may reduce the need for you to send medical records later for review. 0000043989 00000 n 0000041786 00000 n ?t5o7~ 2l7~w3o0B3rq /3}1l?Fc % Npttr}>'1*ePXQl6?WDCBc68:_14%p{}8Tbj XkN,KrfNi+o 0000017945 00000 n 1527 0 obj <>stream NCQA > HEDIS MY 2022 Volume 2 (epub) 0000029274 00000 n 0 0000310525 00000 n 0000313326 00000 n 0000108859 00000 n MEASUREDESCRIPTION OF MEASUREDOCUMENTATION TIPSCOMPLIANCE CODES & MEASURE TIPS Prevention and Screening Cervical Cancer Screening (CCS)* 0000026677 00000 n xref JavaScript seems to be disabled in your browser. 0000032558 00000 n LICENSEE IS RESPONSIBLE FOR PROCURING ALL EQUIPMENT AND SOFTWARE REQUIRED IN CONNECTION WITH THE USE OF HEDIS VOLUME 2. 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). 0000013780 00000 n 0000043726 00000 n An organizations licensed users may use the materials solely for an internal non-commercial purpose without obtaining NCQA approval. 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). 0000043353 00000 n 0000031213 00000 n Commercial specifications should be followed for all required HEDIS 2022 and QARR 2022 NYS-specific measures. 0000034814 00000 n 0000043814 00000 n 0000043682 00000 n o,;6iN?e/.y)>2-@%!H20C@eW D* G^ 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.
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