2023 MBHO Standards and Guidelines (web-based)

EFFECTIVE FOR SURVEYS WITH A START DATE OF JULY 1, 2023 - JUNE 30, 2024
As low as $360.00

NCQA PUBLICATION LICENSE 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"). "Licensee" means only the individual or legal entity whose authorized acceptance appears below as evidence of agreement to the License Agreement terms below.

NOTE: This License Agreement is null and void as related to the following NCQA Products (as such term is defined in Section I below): Risk Adjustment Tables, HEDIS® Medication List Directory and CA DHCS QIP (any) Edition of HEDIS Digital Measures Bundle For ECDS Reporting. Users of these Products will be required to accept a separate Usage Agreement in NCQA's Download Center before accessing the Products. Users must still click the "I AGREE" checkbox at the end of this License Agreement to access those Products, but the terms of this License Agreement will have no legal effect.

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I. Product
This version and any updates to this version provided by NCQA, whether in hard copy or electronic publication, and any related documentation, including, but not limited to, the user's manual, unless provided under the terms of a separate license agreement (collectively, the "Product"). The Product is being licensed (not sold) to you, the Licensee (the "License"). Upon accessing the Product, the Licensee is deemed to have accepted the license subject to the terms and conditions of this License Agreement. Licensee may need additional software to use the Product, and NCQA is not responsible for such additional software.

II. License Grant
NCQA hereby grants Licensee a personal, non-exclusive, non-transferable license to use the Product in accordance with the terms of this License Agreement. As applicable, the Product is licensed for the number of Licensed Users for which a Licensee has paid the applicable fee. "Licensed Users" mean Licensee's employees who may access and use the Product on behalf of the Licensee. A Licensed User must be using the Product under the License and solely on behalf of the Licensee. A Licensed User may not be an agent or consultant of a Licensee. Unauthorized internal distribution of the Product and materials therein - beyond the number of Licensed Users by your organization - is prohibited. Anyone desiring broader internal distribution of the Product must purchase additional Licensed User permissions via the NCQA Store.

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The License is not transferable from Licensee to any other person, entity, organization or association. 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 the Product.

III. License Restrictions
Licensee may not itself or permit others to:

(i) Use the Product or any portion thereof for any purpose other than as specifically set forth in this License Agreement;
(ii) Identify records or calculate HEDIS measure results using the Product;
(iii) Distribute, sublicense or copy the Product in any format, including, but not limited to, other print or electronic publication service or product (except that Licensee may make one [1] copy for each Licensed User for which Licensee has purchased a license to use the Product);
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IV. Prohibited Use Acknowledgment
An organization's Licensed Users may use the Product solely for a personal non-commercial purpose without obtaining NCQA approval.

All other uses, including a commercial use (including but not limited to vendors or consultants using or embedding the measures and specifications and/or Value Set Directory 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.

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 the Product does not constitute a preliminary or final score and does not predict achievement of accreditation, certification or recognition, as applicable. Any use of the Product to identify records or calculate HEDIS measure results, for example, requires a custom license and may necessitate certification pursuant to NCQA's Measure Certification Program. The following activities are expressly prohibited in connection with the use of the Product under this License Agreement:

(i) No individual or entity may use the Product to evaluate another organization against NCQA standards, except as part of Licensee's internal preparation for an NCQA survey or review; and
(ii) Licensee may not allow a third party to view or use the Product.

Licensee agrees to maintain the Product in strict confidence and abide by all terms and conditions of this License Agreement.

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For Value Set Directory (VSD) Downloads. HEDIS VSDs contain code values owned by third parties (the "Third Party Code Values"), including CPT® owned by American Medical Association, LOINC® owned by Regenstrief Institute, Inc., SNOMED CT® owned by the International Health Terminology Standards Development Organisation, and Uniform Billing Codes owned by the American Hospital Association. HEDIS VSDs are made separately available, at no cost, in electronic format. These third party medical and billing codes are protected under federal copyright laws. No license to reproduce, distribute or incorporate the HEDIS VSDs into any product is granted to Licensee by virtue of this License Agreement. All uses of these Third-Party Code Values may require a license from the copyright owner. Licensee acknowledges and agrees that it is responsible for obtaining a license directly from the copyright owner of each of the Third-Party Code Values, if required. Licensee agrees to indemnify and hold NCQA harmless from any claims and expenses arising out of Licensee's use and display of Third-Party Code Values included in the HEDIS VSDs, or any portion thereof.

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NCQA warrants that the media on which the Product 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. 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 the Product.

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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 THE PRODUCT OR ANY PART THEREOF, OR THIS LICENSE AGREEMENT, EXCEED THE PRICE PAID FOR THE PRODUCT, WHETHER SUCH LIABILITY ARISES FROM ANY CLAIM BASED ON CONTRACT, WARRANTY, TORT OR OTHERWISE.

THE LIMITATIONS OF DAMAGES AND LIABILITIES SET FORTH IN THIS LICENSE AGREEMENT ARE FUNDAMENTAL ELEMENTS OF THE BASIS OF THE BARGAIN BETWEEN NCQA AND LICENSEE, AND THE PRICING FOR THE LICENSE REFLECTS SUCH LIMITATIONS. BECAUSE SOME STATES OR JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY FOR DAMAGES (SUCH AS CONSEQUENTIAL OR INCIDENTAL DAMAGES), OR THE EXCLUSION OF IMPLIED WARRANTIES AND LIMITATIONS ON HOW LONG AN IMPLIED WARRANTY MAY LAST, THE ABOVE LIMITATIONS MAY NOT APPLY TO LICENSEE, TO THE EXTENT THAT LIABILITY IS, BY LAW, INCAPABLE OF EXCLUSION OR RESTRICTION.

IX. Remedies and Audit
Any breach of this License Agreement of any terms herein 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. Noncompliance may also disqualify Licensee from receiving future goods and services from NCQA.
To verify compliance with this License Agreement, NCQA is granted the right, with prior notice and during normal business hours, to examine all relevant records of Licensee. Relevant records as used in this paragraph shall include all computer systems; software products; and print and electronic books and records.

X. Severability
If any portion of this License Agreement is determined by a court of competent jurisdiction or any appropriate legislature to be wholly or partially unenforceable, for any reason, such unenforceability shall not affect the balance hereof.

XI. Termination
NCQA may terminate this License Agreement at any time and without notice if Licensee violates any of the terms and conditions hereof. Upon termination of this License Agreement, all rights under this License Agreement, including the license granted to Licensee, will cease. Upon termination, Licensee agrees to immediately return to NCQA or destroy, at NCQA's option, all copies of the Product, together with any back-up copy, modifications and any merged portions, in any form, in Licensee's possession.

XII. Governing Law and General Provisions
This License Agreement shall be governed and construed in accordance with the laws of the District of Columbia without regard to its choice of laws. This License Agreement will not be governed by the United Nations Convention on Contracts for the International Sale of Goods, the application of which is expressly excluded. If any part of this License Agreement is found void and unenforceable, it will not affect the validity of the remainder of the License Agreement, which shall remain valid and enforceable according to its terms. The headings contained in this License Agreement are for reference only and shall not affect the meaning or interpretation of this License Agreement. NCQA's failure to exercise or enforce any right or power under this License Agreement shall not constitute a waiver of such right or power.

XIII. Assignment
Licensee shall not assign this License Agreement without the written consent of NCQA.

XIV. Survival
The provisions of Sections V, VII and VIII of this License Agreement shall survive the termination of this License Agreement.

XV. Modifications
This License Agreement is the complete and exclusive statement of the agreement between Licensee and NCQA, and supersedes any proposal or prior agreement, oral or written, and any other communications between the parties relating to the subject matter of this License Agreement. This License Agreement may not be modified by Licensee except upon mutual agreement by the parties in writing, signed by an authorized representative of NCQA.

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XVII. Contact and Notices
Should Licensee have any questions about this License Agreement or the Product, please call NCQA at (202) 955-3500. All notices to be given under this License Agreement to NCQA shall be submitted to NCQA at 1100 13th Street NW, Washington, D.C. 20005, Attention: Licensee Support. All notices to be given under this License Agreement to Licensee shall be submitted by NCQA via e-mail at the account Licensee provided to NCQA.

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2023 STANDARDS AND GUIDELINES FOR THE ACCREDITATION OF MANAGED BEHAVIORAL HEALTHCARE ORGANIZATIONS

Note: This publication is made accessible in NCQA's Interactive Review Tool (IRT) system. It cannot be downloaded. For a downloadable version of this publication, purchase the epub format instead.

This publication outlines standards and features in-depth explanations and examples of how to meet the standards, accreditation scoring guidelines and points, and accreditation outcomes and reporting categories. Eligibility requirements, application procedures and policies and procedures are also included.

Note: Purchase of the Standards and Guidelines is not necessary if purchasing the Survey Tool, as the Standards are included with the Survey Tool.