2018 CMS Web Interface

Transcription

1 CMS Web Interface HTN-2 (NQF 0018): Cntrlling High Bld Pressure Measure Steward: NCQA CMS Web Interface V2.0 Page 1 f 18 11/13/2017

2 Cntents INTRODUCTION... 3 CMS WEB INTERFACE SAMPLING INFORMATION... 4 BENEFICIARY SAMPLING... 4 NARRATIVE MEASURE SPECIFICATION... 5 DESCRIPTION:... 5 IMPROVEMENT NOTATION:... 5 INITIAL POPULATION:... 5 DENOMINATOR:... 5 DENOMINATOR EXCLUSIONS:... 5 DENOMINATOR EXCEPTIONS:... 5 NUMERATOR:... 5 NUMERATOR EXCLUSIONS:... 5 DEFINITIONS:... 5 GUIDANCE:... 5 SUBMISSION GUIDANCE... 6 PATIENT CONFIRMATION... 6 SUBMISSION GUIDANCE... 7 DENOMINATOR CONFIRMATION... 7 SUBMISSION GUIDANCE... 8 NUMERATOR REPORTING... 8 DOCUMENTATION REQUIREMENTS... 9 APPENDIX I: PERFORMANCE CALCULATION FLOW APPENDIX II: DOWNLOADABLE RESOURCE MAPPING TABLE APPENDIX III: MEASURE RATIONALE AND CLINICAL RECOMMENDATION STATEMENTS RATIONALE: CLINICAL RECOMMENDATION STATEMENTS: APPENDIX IV: USE NOTICES, COPYRIGHTS, AND DISCLAIMERS COPYRIGHT CMS Web Interface V2.0 Page 2 f 18 11/13/2017

3 INTRODUCTION There are a ttal f 15 individual measures (including ne cmpsite cnsisting f tw measures) included in the CMS Web Interface targeting high-cst chrnic cnditins, preventive care, and patient safety. The measures dcuments are represented individually and cntain measure specific infrmatin. The crrespnding cding dcuments are psted separately in an Excel frmat. The Measure Dcuments are being prvided t allw grup practices and Accuntable Care Organizatins (ACOs) an pprtunity t better understand each f the 15 individual measures included in the CMS Web Interface data submissin methd. Each Measure Dcument cntains infrmatin necessary t submit data thrugh the CMS Web Interface. Narrative specificatins, supprting submissin dcumentatin, and calculatin flws are prvided within each dcument. Please review all f the measure dcumentatin in its entirety t ensure cmplete understanding f these measures. CMS Web Interface V2.0 Page 3 f 18 11/13/2017

4 CMS WEB INTERFACE SAMPLING INFORMATION BENEFICIARY SAMPLING Fr mre infrmatin n the sampling prcess and methdlgy please refer t the CMS Web Interface Sampling Dcument, which will be made available during the perfrmance year at CMS.gv. CMS Web Interface V2.0 Page 4 f 18 11/13/2017

5 NARRATIVE MEASURE SPECIFICATION DESCRIPTION: Percentage f patients years f age wh had a diagnsis f hypertensin and whse bld pressure was adequately cntrlled (< 140/90 mmhg) during the measurement perid IMPROVEMENT NOTATION: Higher scre indicates better quality INITIAL POPULATION: Patients years f age wh had a diagnsis f essential hypertensin within the first six mnths f the measurement perid r any time prir t the measurement perid DENOMINATOR: Equals Initial Ppulatin DENOMINATOR EXCLUSIONS: Patients with evidence f end stage renal disease (ESRD), dialysis r renal transplant befre r during the measurement perid. Als exclude patients with a diagnsis f pregnancy during the measurement perid OR Patients age 65 and lder in Institutinal Special Needs Plans (SNP) r Residing in Lng-Term Care with a POS cde 32, 33, 34, 54 r 56 any time during the measurement perid DENOMINATOR EXCEPTIONS: Nne NUMERATOR: Patients whse bld pressure at the mst recent visit is adequately cntrlled (systlic bld pressure < 140 mmhg and diastlic bld pressure < 90 mmhg) during the measurement perid DEFINITION: Nne NUMERATOR EXCLUSIONS: Nt Applicable GUIDANCE: In reference t the numeratr element, nly bld pressure readings perfrmed by a clinician in the prvider ffice are acceptable fr numeratr cmpliance with this measure. Bld pressure readings frm the patient s hme (including readings directly frm mnitring devices) are nt acceptable. If n bld pressure is recrded during the measurement perid, the patient s bld pressure is assumed nt cntrlled. If there are multiple bld pressure readings n the same day, use the lwest systlic and the lwest diastlic reading as the mst recent bld pressure reading. CMS Web Interface V2.0 Page 5 f 18 11/13/2017

6 PATIENT CONFIRMATION SUBMISSION GUIDANCE Establishing patient eligibility fr reprting requires the fllwing: Guidance Determine if the patient s medical recrd can be fund OR OR If yu can lcate the medical recrd select Yes If yu cannt lcate the medical recrd select N - Medical Recrd Nt Fund Determine if the patient is qualified fr the sample If the patient is deceased, in hspice, mved ut f the cuntry r was enrlled in HMO select Nt Qualified fr Sample, select the applicable reasn frm the prvided drp-dwn menu, and enter the date the patient became ineligible Patient Cnfirmatin If N Medical Recrd Nt Fund r Nt Qualified fr Sample is selected, the patient is cmpleted but nt cnfirmed. The patient will be skipped and anther patient must be reprted in their place, if available. The CMS Web Interface will autmatically skip any patient fr whm N Medical Recrd Nt Fund r Nt Qualified fr Sample is selected in all ther measures int which they have been sampled. If Nt Qualified fr Sample is selected and the date is unknwn, yu may enter the last date f the measurement perid (i.e., 12/31/). The Measurement Perid is defined as January 1 December 31,. NOTE: - In Hspice: Select this ptin if the patient is nt qualified fr sample due t being in hspice care at any time during the measurement perid (this includes nn-hspice patients receiving palliative gals r cmfrt care) - Mved ut f Cuntry: Select this ptin if the patient is nt qualified fr sample because they mved ut f the cuntry any time during the measurement perid - Deceased: Select this ptin if the patient died during the measurement perid - HMO Enrllment: Select this ptin if the patient was enrlled in an HMO at any time during the measurement perid (i.e., Medicare Advantage, nn-medicare HMOs, etc.) CMS Web Interface V2.0 Page 6 f 18 11/13/2017

7 DENOMINATOR CONFIRMATION SUBMISSION GUIDANCE Determine if the patient has a dcumented diagnsis f essential HTN within the first six mnths f the measurement perid OR any time prir t the measurement perid but des nt end befre the start f the measurement perid OR OR OR If the patient has a dcumented diagnsis f essential HTN within the first six mnths f the measurement perid OR any time prir t the measurement perid but des nt end befre the start f the measurement perid select Yes If yu are unable t cnfirm a diagnsis f essential HTN within the first six mnths f the measurement perid OR any time prir t the measurement perid but des nt end befre the start f the measurement perid select Nt Cnfirmed - Diagnsis If there is a denminatr exclusin fr patient disqualificatin frm the measure select Denminatr Exclusin If there is an ther CMS apprved reasn fr patient disqualificatin frm the measure select N - Other CMS Apprved Reasn Denminatr and Denminatr Exclusin cdes can be fund in the CMS Web Interface HTN Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance Denminatr If Nt Cnfirmed Diagnsis r Denminatr Exclusin r N Other CMS Apprved Reasn is selected, the patient will be skipped and anther patient must be reprted in their place, if available. The patient will nly be remved frm the measure fr which ne f these ptins was selected, nt all CMS Web Interface measures. CMS Apprved Reasn may nly be selected when apprved by CMS. T request a CMS Apprved Reasn, yu wuld need t prvide the patient rank, measure, and reasn fr request in a CMS Quality Payment Prgram Service Desk inquiry. A CMS decisin will be prvided in the reslutin f the inquiry. Patients fr whm a CMS Apprved Reasn is selected will be skipped and anther patient must be reprted in their place, if available. The intent f the exclusin fr individuals age 65 and lder residing in lng-term care facilities, including nursing hmes, is t exclude individuals wh may have limited life expectancy and increased frailty where the benefit f the prcess may nt exceed the risks. This exclusin is nt intended as a clinical recmmendatin regarding whether the measures prcess is inapprpriate fr specific ppulatins, instead the exclusins allws clinicians t engage in shared decisin making with patients abut the benefits and risks f screening when an individual has limited life expectancy. NOTE: - Essential hypertensin is high bld pressure that desn t have a knwn secndary cause. It is als referred t as primary hypertensin - The fllwing denminatr exclusins cannt end befre the start f the measurement perid: ESRD, Pregnancy, CKD stage 5 - The fllwing denminatr exclusins can start befre r during the measurement perid: Patients underging dialysis, histry f renal transplant CMS Web Interface V2.0 Page 7 f 18 11/13/2017

8 NUMERATOR SUBMISSION SUBMISSION GUIDANCE Determine if the patient's mst recent BP was dcumented during the measurement perid OR If the patient's BP measurement was nt dcumented select N If the patient's BP was dcumented select Yes IF YES Recrd the date the mst recent BP in MM/DD/YYYY frmat AND Enter the systlic and diastlic BP dcumented in mmhg Numeratr cdes can be fund in the CMS Web Interface HTN Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance NOTE: Numeratr - D nt include bld pressure readings that meet the fllwing criteria: Taken n the same day as a diagnstic test r diagnstic r therapeutic prcedure that requires a change in diet r change in medicatin n r ne day befre the day f the test r prcedure, with the exceptin f fasting bld tests. - The bld pressure value cannt be cmpleted during a telehealth encunter CMS Web Interface V2.0 Page 8 f 18 11/13/2017

9 DOCUMENTATION REQUIREMENTS When submitting data thrugh the CMS Web Interface, the expectatin is that medical recrd dcumentatin is available that supprts the actin reprted in the CMS Web Interface i.e., medical recrd dcumentatin is necessary t supprt the infrmatin that has been submitted. Claims data cannt be used t cnfirm a diagnsis (DM, IVD,HTN etc.,) used fr sampling purpses as claims are the riginal surce f the diagnsis sampling. Claims data can be used t prepare the CMS Web Interface Excel, but supprting medical recrd dcumentatin will be required t substantiate what is reprted in the event f an audit. CMS Web Interface V2.0 Page 9 f 18 11/13/2017

10 Appendix I: Perfrmance Calculatin Flw Patient Cnfirmatin Flw Fr, cnfirmatin f the Medical Recrd Fund, r indicating the patient is Nt Qualified fr Sample with a reasn f "In Hspice", "Mved ut f Cuntry", "Deceased", r "HMO Enrllment", will nly need t be dne nce per patient. Start* Mark apprpriately fr cmpletin and STOP ABSTRACTION. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. N Medical Recrd Fund Yes Mark apprpriately fr cmpletin and STOP ABSTRACTION. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. N Patient Qualified fr the Sample. IF NOT, Select the Reasn & Enter Date** Patient Became Ineligible fr Sample (In Hspice, Mved ut f Cuntry, Deceased, HMO Enrllment) Yes Cntinue t Measure Cnf *See the Measure Submissin Dcument fr further instructins n hw t submit this measure **If date is unknwn, enter 12/31/ CMS Web Interface V2.0 Page 10 f 18 11/13/2017

11 Measure Cnfirmatin Flw fr HTN-2 Fr, measure specific reasns a patient is Nt Cnfirmed r excluded fr Denminatr Exclusin r Other CMS Apprved Reasn will need t be dne fr each measure where the patient appears. Start* Cmplete fr cnsecutively ranked patients aged 18 t 85 at the beginning f the measurement perid** Mark apprpriately fr cmpletin and STOP ABSTRACTION. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. N Patient Has a Dcumented Diagnsis f Essential HTN Within the First Six Mnths f the Measurement Perid OR Any Time Prir t the Measurement Perid but Des Nt End Befre the Start f the Measurement Perid Yes Mark apprpriately fr cmpletin and STOP ABSTRACTION. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. N Patient Qualified fr the Measure. IF NOT, Select: Denminatr Exclusin fr Patient Disqualificatin Yes Mark apprpriately fr cmpletin and STOP ABSTRACTION. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be cnsidered a skip and will be replaced. N Patient Qualified fr the Measure. IF NOT, Select: N - Other CMS Apprved Reasn fr Patient Disqualificatin*** Yes Cntinue t Measure Flw *See the Measure Submissin Dcument fr further instructins t submit this measure **Further infrmatin regarding patient selectin fr specific disease and patient care measures can be fund in the CMS Web Interface Sampling Methdlgy Dcument. Fr patients wh have the incrrect date f birth listed, a change f the patient date f birth by the abstractr may result in the patient n lnger qualifying fr the HTN-2 measure. If this is the case, the system will autmatically remve the patient frm the measure requirements. *** Other CMS Apprved Reasn may nly be selected if yu have received an apprval frm CMS in the reslutin f a requested Quality Payment Prgram Service Desk Inquiry at qpp@cms.hhs.gv CMS Web Interface V2.0 Page 11 f 18 11/13/2017

12 Measure Flw fr HTN-2 Start* Include Remainder f Patients Listed in CMS Web Interface that were Cnsecutively Cnfirmed and Cmpleted fr this Measure in the Denminatr d (i.e., 240 Patients) The measure diagrams were develped by CMS as a supplemental resurce t be used in cnjunctin with the measure specificatins. They shuld nt be used as a substitutin fr the measure specificatin. Fr Dwnladable Resurce Mapping Table, g t Appendix II and use the Variable Names lcated in the appendix alng with the applicable tabs within the HTN Cding Dcument. Patient s Mst Recent Bld Pressure Was Dcumented During the Measurement Perid N Perfrmance Nt Met: D Nt Include in Numeratr Yes Recrd the date f the mst recent BP in MM/DD/YYYY frmat, enter the systlic BP dcumented in mmhg, and enter the diastlic BP dcumented in mmhg Patient s Mst Recent Bld Pressure During the Measurement Perid was >0 but <140/90 mmhg Yes Perfrmance Met: Include in Numeratr (i.e., 190 Patients) a N Perfrmance Nt Met: D Nt Include in Numeratr SAMPLE CALCULATION: Perfrmance Rate= Perfrmance Met (a=190 Patients) 190 Patients = 79.17% Denminatr (d=240 Patients) = 240 Patients CALCULATION MAY CHANGE PENDING PERFORMANCE MET ABOVE *See the Measure Submissin Dcument fr further instructins n hw t submit this measure CMS Web Interface V2.0 Page 12 f 18 11/13/2017

13 Patient Cnfirmatin Flw Fr, cnfirmatin f the Medical Recrd Fund, r indicating the patient is Nt Qualified fr Sample with a reasn f In Hspice, Mved ut f Cuntry, Deceased, r HMO Enrllment, will nly need t be dne nce per patient. Refer t the Measure Submissin Dcument fr further instructins. 1. Start Patient Cnfirmatin Flw. 2. Check t determine if Medical Recrd can be fund. a. If n, Medical Recrd nt fund, mark apprpriately fr cmpletin and stp abstractin. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. Stp prcessing. b. If yes, Medical Recrd fund, cntinue prcessing. 3. Check t determine if Patient Qualified fr the sample. a. If n, the patient des nt qualify fr the sample, select the reasn why and enter the date (if date is unknwn, enter 12/31/) the patient became ineligible fr sample. Fr example; In Hspice, Mved ut f Cuntry, Deceased, HMO Enrllment. Mark apprpriately fr cmpletin and stp abstractin. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient des qualify fr the sample; cntinue t the Measure Cnfirmatin Flw fr HTN-2. CMS Web Interface V2.0 Page 13 f 18 11/13/2017

14 Measure Cnfirmatin Flw fr HTN-2 Fr, measure specific reasns a patient is Nt Cnfirmed r excluded fr Denminatr Exclusin r Other CMS Apprved Reasn will need t be dne fr each measure where the patient appears. Refer t the Measure Submissin Dcument fr further instructins. 1. Start Measure Cnfirmatin Flw fr HTN-2. Cmplete fr cnsecutively ranked patients aged 18 t 85 at the beginning f the measurement perid. Further infrmatin regarding patient selectin fr specific disease and patient care measures can be fund in the CMS Web Interface Sampling Methdlgy Dcument. Fr patients wh have the incrrect date f birth listed, a change f the patient date f birth by the abstractr may result in the patient n lnger qualifying fr the HTN-2 measure. If this is the case, the system will autmatically remve the patient frm the measure requirements. 2. Check t determine if the patient has a dcumented diagnsis f essential HTN within the first six mnths f the measurement perid OR any time prir t the measurement perid but des nt end befre the start f the measurement perid. a. If n, the patient des nt have a dcumented diagnsis f essential HTN within the first six mnths f the measurement perid OR any time prir t the measurement perid, mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient des have a dcumented diagnsis f essential HTN within the first six mnths f the measurement perid OR any time prir t the measurement perid but des nt end befre the start f the measurement perid, cntinue prcessing. 3. Check t determine if the patient qualifies fr the measure (Denminatr Exclusin). a. If n, the patient des nt qualify fr the measure select: Denminatr Exclusin fr patient disqualificatin. Mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient des qualify fr the measure, cntinue prcessing. 4. Check t determine if the patient qualifies fr the measure (Other CMS Apprved Reasn). a. If n, the patient des nt qualify fr the measure select: N Other CMS Apprved Reasn fr patient disqualificatin. Mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Other CMS Apprved Reasn may nly be selected if yu have received an apprval frm CMS in the reslutin f a requested Quality Payment Prgram Service Desk Inquiry at qpp@cms.hhs.gv. Stp prcessing. b. If yes, the patient des qualify fr the measure, cntinue t HTN-2 measure flw. CMS Web Interface V2.0 Page 14 f 18 11/13/2017

15 Measure Flw fr HTN-2 The measure diagrams were develped by CMS as a supplemental resurce t be used in cnjunctin with the measure specificatins. They shuld nt be used as a substitutin fr the measure specificatins. Fr Dwnladable Resurce Mapping Table, g t Appendix II and use the Variable Names lcated in the appendix alng with the applicable tabs within the HTN Cding Dcument. 1. Start prcessing HTN-2 (NQF 0018) Flw fr the patients that qualified fr sample in the Patient Cnfirmatin Flw and the Measure Cnfirmatin Flw fr HTN-2. Nte: Include remainder f patients listed in the CMS Web Interface that were cnsecutively cnfirmed and cmpleted fr this measure in the denminatr. Fr the sample calculatin in the flw these patients wuld fall int the d categry (eligible denminatr, i.e. 240 patients). 2. Check t determine if the patient s mst recent bld pressure was dcumented during the measurement perid. a. If n, the patient s mst recent bld pressure was nt dcumented during the measurement perid, perfrmance is nt met and the patient shuld nt be included in the numeratr. Stp prcessing. b. If yes, the patient s mst recent bld pressure was dcumented during the measurement perid, recrd the date f the mst recent BP in MM/DD/YYYY frmat, enter the systlic BP dcumented in mmhg, and enter the diastlic BP dcumented in mmhg. Cntinue prcessing. 3. Check t determine if the patient s mst recent bld pressure during the measurement perid was greater than zer but less than 140 ver 90 mmhg. a. If n, the patient s mst recent bld pressure during the measurement perid was nt greater than zer r less than 140 ver 90 mmhg, perfrmance is nt met and the patient shuld nt be included in the numeratr. Stp prcessing. b. If yes, the patient s mst recent bld pressure during the measurement perid was greater than zer but less than 140 ver 90 mmhg, perfrmance is met and the patient will be included in the numeratr. Fr the sample calculatin in the flw these patients wuld fall int the a categry (numeratr, i.e. 190 patients). Stp prcessing. Sample Calculatin Perfrmance Rate Equals Perfrmance Met is categry a in the measure flw (190 patients) Denminatr is categry d in measure flw (240 patients) 190 (Perfrmance Met) divided by 240 (Denminatr) equals a perfrmance rate f percent Calculatin May Change Pending Perfrmance Met CMS Web Interface V2.0 Page 15 f 18 11/13/2017

16 Appendix II: Dwnladable Resurce Mapping Table Each data element within this measure s denminatr r numeratr is defined as a pre-determined set f clinical cdes. These cdes can be fund in the CMS Web Interface HTN Cding Dcument. Measure Cmpnent/Excel Tab Denminatr/Denminatr Cdes Denminatr Exclusin/Denminatr Exclusin Cdes *HTN-2: Cntrlling High Bld Pressure Data Element Variable Name Cding System(s) Hypertensin HTN_DX_CODE I9 Diagnsis I10 SNM CKD_CODE I9 I10 SNM DIALYSIS_CODE C4 HCPCS SNM ESRD_CODE I9 Exclusins I10 C4 SNM KIDNEY_TRANS_CODE C4 HCPCS SNM PREGNANCY_CODE I10 SNM Numeratr/Numeratr Cdes Bld Pressure SYSTOLIC_CODE AND DIASTOLIC_CODE *Fr EHR mapping, the cding within HTN-2 is cnsidered t be all inclusive LN WITH mst recent bld pressure date and value CMS Web Interface V2.0 Page 16 f 18 11/13/2017

17 Appendix III: Measure Ratinale and Clinical Recmmendatin Statements RATIONALE: Hypertensin, r high bld pressure, is a very cmmn and dangerus cnditin that increases risk fr heart disease and strke, tw f the leading causes f death fr Americans (Farley et al., 2010). Cmpared with ther dietary, lifestyle, and metablic risk factrs, high bld pressure is the leading cause f death in wmen and the secnd-leading cause f death in men, behind smking (Danaei et al., 2011). Apprximately 1 in 3 U.S. adults, r abut 70 millin peple, have high bld pressure but nly abut half (52%) f these peple have their high bld pressure under cntrl. Additinally, data frm NHANES 2011 t 2012 fund that 17.2% f U.S. adults are nt aware they have hypertensin (Nwankw et al., 2013). Prjectins shw that by 2030, apprximately 41.4% f US adults will have hypertensin, an increase f 8.4% frm 2012 estimates (Heidenreich et al., 2011). The estimated direct and indirect cst f high bld pressure fr 2011 is $46.4 billin. This ttal includes direct csts such as the cst f physicians and ther health prfessinals, hspital services, prescribed medicatins and hme health care, as well as indirect csts due t lss f prductivity frm premature mrtality (Mzaffarian et al., 2015). Prjectins shw that by 2030, the ttal cst f high bld pressure culd increase t an estimated $274 billin (Heidenreich et al., 2011). Better cntrl f bld pressure has been shwn t significantly reduce the prbability that undesirable and cstly utcmes will ccur. In clinical trials, antihypertensive therapy has been assciated with reductins in strke incidence (35-40%), mycardial infarctin (20-25%) and heart failure (>50%) (Chbanian et al., 2003). Thus, the relatinship between the measure (cntrl f hypertensin) and the lng-term clinical utcmes listed is well established. CLINICAL RECOMMENDATION STATEMENTS: The United States Preventive Services Task Frce (2007) recmmends screening fr high bld pressure in adults age 18 years and lder. This is a grade A recmmendatin. Jint Natinal Cmmittee n Preventin, Detectin, Evaluatin, and Treatment f High Bld Pressure (2003): Treating systlic bld pressure and diastlic bld pressure t targets that are <140/90 mmhg is assciated with a decrease in cardivascular disease cmplicatins. CMS Web Interface V2.0 Page 17 f 18 11/13/2017

18 Appendix IV: Use Ntices, Cpyrights, and Disclaimers COPYRIGHT The measures and specificatins were develped by and are wned by the Natinal Cmmittee fr Quality Assurance ( NCQA ). NCQA hlds a cpyright in the measures and specificatins and may rescind r alter these measures and specificatins at any time. Users f the measures and specificatins shall nt have the right t alter, enhance r therwise mdify the measures and specificatins, and shall nt disassemble, recmpile r reverse engineer the measures and specificatins. Anyne desiring t use r reprduce the materials withut mdificatin fr a nn-cmmercial purpse may d s withut btaining any apprval frm NCQA. All cmmercial uses r requests fr alteratin f the measures and specificatins must be apprved by NCQA and are subject t a license at the discretin f NCQA. The measures and specificatins are nt clinical guidelines, d nt establish a standard f medical care and have nt been tested fr all ptential applicatins. The measures and specificatins are prvided as is withut warranty f any kind. NCQA makes n representatins, warranties r endrsements abut the quality f any prduct, test r prtcl identified as numeratr cmpliant r therwise identified as meeting the requirements f a measure r specificatin. NCQA als makes n representatins, warranties r endrsements abut the quality f any rganizatin r clinician wh uses r reprts perfrmance measures. NCQA has n liability t anyne wh relies n measures and specificatins r data reflective f perfrmance under such measures and specificatins Natinal Cmmittee fr Quality Assurance, all rights reserved. Perfrmance measures develped by NCQA fr CMS may lk different frm the measures slely created and wned by NCQA. Limited prprietary cding is cntained in the measure specificatins fr cnvenience. Users f the prprietary cde sets shuld btain all necessary licenses frm the wners f these cde sets. NCQA disclaims all liability fr use r accuracy f any cding cntained in the specificatins. The American Medical Assciatin hlds a cpyright t the CPT cdes cntained in the measures specificatins. CMS Web Interface V2.0 Page 18 f 18 11/13/2017