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A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. THE LIMITATIONS OF DAMAGES AND LIABILITIES SET FORTH IN THIS AGREEMENT ARE FUNDAMENTAL ELEMENTS OF THE BASIS OF THE BARGAIN BETWEEN NCQA AND LICENSEE. Kevin Buchan, Jr., Ph.D., AVP of Analytics at ApolloMed, said, "We are very excited about this measurement year's certification from NCQA. 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. Official websites use .govA May/June 2023 IssueSUBSCRIBER CONTENT Disruptors or non-traditional providers are quickly accelerating their footprint into the care-at-home market. She has worked with more than 10,000 organizations in both a consultancy role and an educator. WHEREAS, NCQA desires to provide Licensee with a license to use HEDIS Volume 2 in accordance with the terms of this Agreement. 0000107118 00000 n
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lock CMS publishes the Star Ratings each year to measure the quality of health services received by consumers enrolled in Medicare Advantage Plans. %PDF-1.7
HEDIS MY 2023 Volume 2: Technical Specifications for Health Plans View Table of Contents for this Publication. 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. The below information describes the measure . Hospitals will be required to report what portion of their population is screened for various SDOH and how many screen positive in each category. 0000008114 00000 n
ALHAMBRA, Calif., June 22, 2023 /PRNewswire/ -- Apollo Medical Holdings, Inc. ("ApolloMed," and together with its subsidiaries and affiliated entities, the "Company") (NASDAQ: AMEH), a leading physician-centric, technology-powered healthcare company focused on enabling providers in the successful delivery of value-based care, today announced that it received certification from the National Committee for Quality Assurance ("NCQA") Healthcare Effectiveness Data and Information Set ("HEDIS") Health Plan Measure Certification Program. The overall rating is the weighted average of a plan's HEDIS and CAHPS measure ratings, plus bonus points for plans with a current Accreditation status as of June 30, 2023. June 29: CMS announced a new funding opportunity for minority health researchers as part of the Health Equity Data Access Program (HEDAP). CMS Announces Funding Opportunity for Minority Health Researchers. (Marketplace), Medicare . Usability: Report measures for HEDIS MY 2023 and other quality reporting programspossible because measures use Health Level Seven International (, Appropriate Testing for Pharyngitis (CWP), Appropriate Treatment for Upper Respiratory Infection (URI), Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB), Depression Remission or Response for Adolescents and Adults (DRR-E), Depression Screening and Follow-Up for Adolescents and Adults (DSF-E), Follow-Up After Emergency Department Visit for Mental Illness (FUM), Follow-Up Care for Children Prescribed ADHD Medication (ADD-E), Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E), Non-Recommended PSA-Based Screening in Older Men (PSA), Postpartum Depression Screening and Follow-Up (PDS-E), Prenatal Depression Screening and Follow-Up (PND-E), Social Need Screening and Intervention (SNS-E), Unhealthy Alcohol Use Screening and Follow-Up (ASF-E), Use of Opioids from Multiple Providers (UOP), Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E). 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"). CMS Increases Nursing Home Transparency with Ownership/Affiliation Data, Plus Entity Safety, Staffing & Quality Metrics. 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 Licensee's use, reproduction, distribution, incorporation or display of the Third-Party Codes. 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. 0000002306 00000 n
The Inflation Reduction Act (IRA) mandates Medicaid and CHIP coverage of Food and Drug Administration approved adult vaccines recommended by the Advisory Committee on Immunization Practices and their administration, without cost-sharing beginning October 1, 2023. An email will be sent to you with a password reset link. CMS Approves Marylands 1332 Waiver Extension Request. Information is in the HEDIS Measurement Year 2020 & Measurement Year 2021 Volume 2: Technical Specifications for Health Plans. 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. The proposed rule will be published in the. It includes proposals to introduce three new electronic clinical quality measures (eCQMs) to the CMS Inpatient Quality Reporting Program. 0000019585 00000 n
Millions of people with Medicare Part D are already benefiting from the Inflation Reduction Acts $35 monthly cap, and if these rules for Part B and Part D had been in effect in 2020, 1.5 million beneficiaries would have saved an average of $500 per year. Remingtons Home Care Leadership Think Tank brings together the nations home-based care leadership and healthcare ecosystem partners who have a vested interest in the advancement of home-based care and who seek to improve care delivery through mutually beneficial referral partnerships. NCQA HEDIS Health Plan Measure Certification Program is a trademark of NCQA. Subject to the terms and conditions of this Agreement, NCQA grants Licensee a personal, limited, non-exclusive, non-transferable license in the United States to use HEDIS Volume 2 during the term of this Agreement solely for internal, non-commercial purposes in accordance with the terms of this Agreement (the "License"). 1.2 "Marks" means the NCQA trademarks and/or service marks related to the Licensed Measure Specifications described in Section 5. The TAC will aid Medicaid agencies, local education agencies (LEAs), and school-based entities. All uses of such Third-Party Codes may require a license from the copyright owner, which Licensee acknowledges and agrees that it is solely responsible for obtaining directly from the copyright owners and that NCQA has no liability or responsibility for such Third-Party Codes or claims arising out of the use thereof by Licensee. Details can be found on this, ; additional information on the model, including a link to the participants list, can be found. TO THE MAXIMUM EXTENT ALLOWABLE BY LAW, THE PARTIES DISCLAIM THE APPLICABILITY OF THE UNIFORM COMMERCIAL CODE OR OTHER UNIFORM LAWS. In this case, you should ask the security team of your IT department to whitelist incoming mail originating from the following IPs: You should also ask them to whitelist the domain: remingtonreport.com. . Because so many health plans use HEDIS and because the measures are so specifically defined, HEDIS can be used to make comparisons among plans. Lisa monitors the complex key trends and forces of change to develop a correct strategic approach to de-risk decision-making and create sustainable futures across the healthcare continuum. We explain the quality measures across providers and stakeholders. 0000013614 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 NCQA's HEDIS measures and specifications; WHEREAS, Licensee desires to use HEDIS Volume 2; and. 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. We are strong believers in equitable access to high-quality, culturally competent healthcare for all, and remain committed to building technologies that will help lower administrative costs while improving operating efficiencies, quality of care, and access to care. June 28: As part of the Biden-Harris Administrations ongoing initiative to increase the transparency of corporate ownership in the nations nursing homes, CMS posted additional nursing home ownership and operator affiliation data on Nursing Home Compare. 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. All organizations that submit HEDIS summary contract-level data are also required to submit audited HEDIS Patient-Level Detail (PLD) data files to CMS's HEDIS PLD contractor. Supreme Court shuts down student loan forgiveness: What happens now? 872 63
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. Healthcare Effectiveness Data and Information Set (HEDIS) Measure for 2023Lead Screening in Children (LSC)Guidelines Update. CodeToolz - Managed Care Contract Negotiations. Lost your password? . For more insights on Medicare managed care social determinants, read Nine Payer and State Medicaid Managed Care Investments in Social Determinants.. "Licensee" means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the Agreement terms below. Measures relate to many significant public health issues such as cancer, heart disease, behavioral health and diabetes. . JavaScript seems to be disabled in your browser. in their efforts to deliver expanded Medicaid services to students. Submit this inquiry by logging intoMy NCQA, selecting theAsk a Questionbutton, then theOrdersbutton, then theCustom License Requestsoption. endobj
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1. patients between the ages of six months to six years (72 months) must comply. One of the most notable changes. ", Yubin Park, Ph.D., Chief Data and Analytics Officer at ApolloMed, stated, "We are pleased to add our RESTful API interface for HEDIS measures to our analytics platform, which also includes our social determinants of health analytics tool and risk insights tool. The screening looks at food, housing, and transportation needs. 0000008866 00000 n
View Table of Contents for this Publication. Weight = 1 . IRA Extends Insulin Cost Caps to Medicare Part B and Medicare Advantage Starting July 1. NCQA introduced race and ethnicity stratification into HEDIS quality measures in 2022. 2023-06-15T10:44:10-04:00By Lisa Remington|2023 Issue 3 May-Jun, ACOs & Health Systems, Current Issue, FutureFocus, Home Health, Hospice & Palliative Care, Remington Report|. Headquartered in Alhambra, California, ApolloMed's subsidiaries and affiliates include management services organizations (MSOs), affiliated independent practice associations (IPAs), and entities participating in the Centers for Medicare & Medicaid Services Innovation Center (CMMI) innovation models. 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. CHIPRA; Medicaid; measure list" Created Date: 2/10/2023 12:43:11 PM . Through HEDAP, CMS will support up to three seats in theCMS Virtual Research Data Center (VRDC), with each individual grant worth up to $90,000. Value sets - Some measure specifications reference value sets that must be used for calculating the For the best experience on our site, be sure to turn on Javascript in your browser. stream
Overall, the changes to 2023 HEDIS and CMS Star Rating measures reflect the ongoing evolution of healthcare delivery and the importance of measuring the quality of care provided through telehealth and other new modalities. Having a metric that identifies social needs provides information that is necessary to begin to address the barriers to pursuing health for patients and individuals. The movement toward value-based care has brought those social factors to the center of the conversation. 0000095319 00000 n
NCQA may terminate this Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. . 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. endobj
Licensee agrees that it will not seek to register any of NCQA's Marks or other indicia consisting of or incorporating any element of the Marks, or variations thereof, in any jurisdictions. for Stars is 50-75 years old . As the agency states, "this effort builds on NCQA's existing work dedicated to advancing health equity in data and quality measurement.". RESOURCES FOR HEALTH PLANS NCQA's Health Plan Ratings 2023 include commercial, Medicare and Medicaid health plans. If you can see our newsletters there, then you should whitelist them/report them as not spam. Across the 67 group practices, there are over 600 sites of care representing approximately 37 states and over 3,000 unique practitioners. Some CAHPS surveys are used in Value-Based Purchasing (Pay for Performance) initiatives. Technology investments such as this allow us to reinvest more into best-in-class patient care and our provider partners, a virtuous cycle that we are excited to further accelerate.". 0000007643 00000 n
HEDIS data help identify performance gaps and establish realistic targets for improvement. The proposal also calls for data collection that could be used to help clinicians and patients make better-informed treatment decisions. The obligations of both Parties shall not terminate upon any assignment or delegation attempted without such prior written consent. Be sure to check your spam and/or junk mail folders for the email. THE USE OF THE LICENSED MEASURE SPECIFICATIONS IS ENTIRELY AT LICENSEE'S OWN RISK AND NCQA SHALL HAVE NO LIABILITY OR RESPONSIBILITY THEREFOR. Retired Measures Breast Cancer Screening (BCS) *. For 2024, CMS proposes increasing ESRD PPS total payments to ESRD facilities by approximately 1.6 percent compared to 2023. 0000009139 00000 n
30262 Crown Valley Parkway 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. To ensure that HEDIS stays current, the National Committee for Quality Assurance (NCQA) has established a process to evolve the measurement set each year through its Committee on Performance Measurement. Details are available in the fact sheet. 0000022253 00000 n
NCQA's 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. The National Committee for Quality Assurance (NCQA) has released proposed updates and changes to HEDIS measures for Measurement Year 2023 (MY 2023) for public feedback, with the public comment period ending Friday, March 11. The listed Keep in mind this dialogue sets the tone for the relationship. Details and additional information can be found in this, about how people can get drugs that may slow the progression of Alzheimers disease covered by Medicare. June 23: The U.S. Virgin Islands (USVI) received approval to extend postpartum coverage for a full year after pregnancy for individuals enrolled in Medicaid. June 23: CMS is working with the Department of Education to help states bring health care to kids at schools to maximize Medicaid coverage and grow connections to care. All California providers who perform Periodic Health Assessments (PHA) on. to increase the transparency of corporate ownership in the nations nursing homes, CMS posted additional nursing home ownership and operator affiliation data on, the Nursing Home Affiliated Entity Performance Measures dataset on. For more information, please visit www.apollomed.net. Payers wanted to improve their performance on . 0000127727 00000 n
Rate 2: Two additional well-child visits 15 to 30 months. Researchers selected for the grant will receive funding for a period of thirty-six months. CMS measures Centers for Medicare & Medicaid Services (CMS) Part D medication adherence measures are used to help increase the number of Medicare members taking their cholesterol (statin), diabetes and/or hypertension (RAS antagonist) medications as prescribed. This information can also be used by states to gain more information about prospective owners and operators of nursing homes prior to certification of new nursing homes and during change of ownership requests. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Healthcare Effectiveness Data and Information Set (HEDIS), CMS contracts with NCQA to collect Healthcare Effectiveness Data and Information Set (HEDIS, Use of Spirometry Testing in the Assessment and Diagnosis of COPD, Pharmacotherapy Management of COPD Exacerbation, Persistence of Beta-Blocker Treatment After a Heart Attack, Osteoporosis Management in Women Who Had a Fracture, Follow-Up After Hospitalization for Mental Illness, Potentially Harmful Drug-Disease Interactions in Older Adults, Use of High-Risk Medications in Older Adults, Transitions of Care (Reporting began in HEDIS MY 2020), Chronic Condition Special Needs Plans (C-SNPs), Dual Eligible Special Needs Plans (D-SNPs), Institutional Special Needs Plans (I-SNPs).
[email protected], Copyright 2012 document.write(new Date().getFullYear());|The Remington Report|All Rights Reserved|Privacy Policy|Terms & Conditions|Powered by LeadWorks. Recent RFPs have included requirements that MCOs incorporate SDOH into their quality assessment and performance improvement (QAPI) programs and that MCOs provide SDOH training for staff. A required resource for anyone involved in collecting, calculating or submitting HEDIS data, Volume 2 features the complete technical specifications for each measure. Suite B 407 MCAS is based on the Centers for Medicare and Medicaid Services Child and Adult Core Set Measures, which includes NCQA HEDIS measures. May/June 2023 IssueFREE CONTENT In the May/June issue of The Remington Report, we provide a special industry report for home-based care providers to identify the gaps in care delivery. The quality of services is measured clinically, administratively, and through the use of patient experience of care surveys. This approach is consistent with the. 7500 Security Boulevard, Baltimore, MD 21244, Starting July 1, people with Medicare Part B and Medicare Advantage coverage who get their insulin through a traditional pump will see insulin costs capped at $35 per month per each covered insulin. Primarily focused on improving preventive care, HEDIS is touted as the gold standard of #valuebasedcare performance. the data is included in the submission to CMS. Launching on July 1, 2023, the five-year model test is aligned with the Biden-Harris Administrations Cancer Moonshot priorities to support patients, caregivers, and survivors and address inequities. HEDIS MY 2021 Patient-Level Detail data files. Relevant records as used in this paragraph shall include all computer systems; software products; and print and electronic books and records. 0000012290 00000 n
States are increasingly requiring MCO care management programs to incorporate SDOH, to coordinate with community-based organizations and to ensure referrals to social services and supports. An official website of the United States government. 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. Additionally, some states are contractually requiring MCOs to either encourage or require their provider networks to incorporate SDOH needs screening into their practices. Payers understand the tremendous staff burden on providers and are willing to reimburse them for their efforts. 0000018867 00000 n
NOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable. The 2024 star ratings (2022 DOS) are expected to consist of 38 measures across the following five domains: Star measure weights and cut-points Star measures are categorized into the following three measures and weighted accordingly: Asthma medication use. These providers are addressing the pain points and healthcare gaps that traditional-for-service providers have failed to correct for many years. 2023 HEDIS Updates The updates to HEDIS requirements and measures for 2023 focus on #telehealth, cancer screening, pediatric oral care and diabetic care. Additional updates to this manual are anticipated in 2023 to introduce corresponding measures for Medicaid fee-for-service long-term services and supports programs and further align the CMS Medicaid MLTSS measures and their HEDIS equivalents . HEDIS/CAHPS Measures Required for HP AccreditationMedicare Measure Name Display Name Weight* PATIENT EXPERIENCE Getting Care Getting Needed Care (Usually + Always) Getting care easily 1.5 Getting Care Quickly (Usually + Always) Getting care quickly 1.5 Satisfaction With Plan Physicians Rating of Personal Doctor (9 + 10) Rating of primary . Measure Name . HEDIS Volume 2 is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. Catherine Howden, DirectorMedia Inquiries Form Forgot your password? June 22: CMS released new details about how people can get drugs that may slow the progression of Alzheimers disease covered by Medicare. CMS Issues ESRD Proposed Payment Rule for Calendar Year (CY) 2024. Oral health is vital to patients overall well-being, especially children. The full HEDIS digital measure specifications are only available by purchasing a HEDIS digital measure product. 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. the HEDIS 2023 Volume 2 Technical Specifications by NCQA and is subject to change. Referral Partnership & Engagement Strategies, Roadmapping Care at Homes Future: Trends & Forecasts Predict Whats Ahead, Complimentary Subscription to FutureFocus, Not Receiving Our Newsletters? 0000001587 00000 n
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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. Measure evaluates percentage of members 18-75 years of age with diabetes (type 1 and type 2) whose HbA1c was at the following levels: HbA1c control (<8.0%) HbA1c . 0000018429 00000 n
June 23: CMS is working with the Department of Education to help states bring health care to kids at schools to maximize Medicaid coverage and grow connections to care. Workforce: How Will Medicare Fee-For-Service Trends Change the Way You Think About Future Staffing Needs?
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