Access to Preventive/ Ambulatory Health Services for Adult Medicaid Members with SMI

LICENSE AGREEMENTS AND ACKNOWLEDGMENTS

Use of the Manual for the Medicaid Section 1115 Serious Mental Illness and Serious Emotional Disturbance Demonstrations: Technical Specifications for Monitoring Metrics indicates acceptance of the following license agreements.

The American Medical Association (AMA) and the American Hospital Association (AHA) permit the use of Current Procedural Terminology (CPT) and National Uniform Billing Committee (NUBC) UB-04 codes solely for the purpose of reporting state data on Medicaid and Children’s Health Insurance Program (CHIP) measures to the Centers for Medicare & Medicaid Services (CMS).

The National Committee for Quality Assurance (NCQA) and The Joint Commission (TJC) permit the use of their technical specifications solely for the purpose of reporting state data on Medicaid and CHIP measures to the Centers for Medicare & Medicaid Services (CMS).

For Proprietary Codes in the Technical Specifications:

CPT® codes copyright 2021 American Medical Association (AMA). All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

The American Hospital Association (AHA) holds a copyright to the Uniform Billing Codes (“UB”). The UB Codes in the technical specifications are included with the permission of the AHA. The UB Codes contained in the technical specifications may be used only to report state measure results or to use state measure results for internal, noncommercial quality improvement purposes. All other uses of the UB Codes require a license from the AHA. Anyone desiring to use the UB Codes in a commercial product to generate measure results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact ub04@aha.org.

For Codes in the Public Domain:

The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is published by the World Health Organization (WHO). ICD-10-CM is an official Health Insurance Portability and Accountability Act standard.

The International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) is published by the World Health Organization (WHO). ICD-10-PCS is an official Health Insurance Portability and Accountability Act standard.

The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is published by the World Health Organization (WHO). ICD-9-CM is an official Health Insurance Portability and Accountability Act standard.

The International Classification of Diseases, 9th Revision, Procedure Coding System (ICD-9-PCS) is published by the World Health Organization (WHO). ICD-9-PCS is an official Health Insurance Portability and Accountability Act standard.

The National Drug Code (NDC) Directory is published by the U.S. Food and Drug Administration and is made available under the Open Database License: http://opendatacommons.org/licenses/odbl/1.0/. Any rights on individual contents of the database are licensed under the Database Contents License: http://opendatacommons.org/licenses/dbcl/1.0/.

For National Committee for Quality Assurance (NCQA) measures in the technical specifications for section 1115 SMI/SED demonstration monitoring metrics:

Content reproduced with permission from HEDIS MY 2021 Volume 2: Technical Specifications for Health Plans by the National Committee for Quality Assurance (NCQA). HEDIS® is a registered trademark of NCQA. HEDIS measures and specifications are not clinical guidelines and do not establish a standard of medical care. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. Anyone desiring to use or reproduce the materials without modification for a non-commercial purpose may do so without obtaining any approval from NCQA. All commercial uses must be approved by NCQA and are subject to a license at the discretion of NCQA.

The measure specification methodology used by CMS is different from NCQA's methodology. NCQA has not validated the adjusted measure specifications but has granted CMS permission to adjust. Calculated measure results based on the adjusted HEDIS specifications may be called only "Adjusted, Uncertified, Unaudited HEDIS rates."

Certain non-NCQA measures in the CMS section 1115 SMI/SED technical specifications contain HEDIS Value Sets (VS) developed by and included with the permission of the NCQA. NCQA disclaims all liability for use or accuracy of the HEDIS VS within the non-NCQA measures.

Limited proprietary coding is contained in the measure specifications and HEDIS VS for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. NCQA disclaims all liability for use or accuracy of any coding contained in the specifications and HEDIS VS.

The American Medical Association holds a copyright to the CPT® codes contained in the measure specifications and HEDIS VS.

The American Hospital Association holds a copyright to the Uniform Billing Codes ("UB") contained in the measure specifications and HEDIS VS. The UB Codes are included with the permission of the AHA. Anyone desiring to use the UB Codes in a commercial product to calculate measure results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact ub04@aha.org.

MEASURE RATE NOTICE

States must prominently display the following notice on any display of measure rates based on NCQA technical specifications for section 1115 SMI/SED demonstration monitoring metrics:

The MPT, FUH-CH, FUH-AD, FUA-AD, FUM-AD, AAP, and APM measures (Metrics #7, 8, 9, 10, 13, 14, 15, 16, 17, 18, 26, 29) are Healthcare Effectiveness Data and Information Set (HEDIS®) measures that are owned and copyrighted by the National Committee for Quality Assurance (NCQA). HEDIS measures and specifications are not clinical guidelines, do not establish a standard of medical care and have not been tested for all potential applications. The measures and specifications are provided “as is” without warranty of any kind. NCQA makes no representations, warranties or endorsements about the quality of any product, test or protocol identified as numerator compliant or otherwise identified as meeting the requirements of a HEDIS measure or specification. NCQA makes no representations, warranties, or endorsement about the quality of any organization or clinician who uses or reports performance measures and NCQA has no liability to anyone who relies on HEDIS measures or specifications or data reflective of performance under such measures and specifications.

The measure specification methodology used by CMS is different from NCQA’s methodology. NCQA has not validated the adjusted measure specifications but has granted CMS permission to adjust. A calculated measure result (a “rate”) from a HEDIS measure that has not been certified via NCQA’s Measure Certification Program, and is based on adjusted HEDIS specifications, may not be called a “HEDIS rate” until it is audited and designated reportable by an NCQA-Certified HEDIS Compliance Auditor. Until such time, such measure rates shall be designated or referred to as “Adjusted, Uncertified, Unaudited HEDIS rates.”

Limited proprietary coding is contained in the measure specifications and HEDIS VS for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. NCQA disclaims all liability for use or accuracy of any coding contained in the specifications and HEDIS VS.

The American Medical Association holds a copyright to the CPT® codes contained in the measure specifications and HEDIS VS.

The American Hospital Association holds a copyright to the Uniform Billing Codes ("UB") contained in the measure specifications and HEDIS VS. The UB Codes are included with the permission of the AHA. Anyone desiring to use the UB Codes in a commercial product to calculate measure results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact ub04@aha.org.