License Agreement 2020 Health Homes Core Set

Use of the Technical Specifications, Resource Manual, and Value Sets for the Health Homes Core Set indicates acceptance of the following license agreements.

The American Medical Association (AMA), the American Dental Association (ADA), and the American Hospital Association (AHA) permit the use of Current Procedural Terminology (CPT), Current Dental Terminology (CDT), and National Uniform Billing Committee (NUBC) UB-04 codes solely for the purpose of reporting state data on Medicaid and CHIP Core Set measures to the Centers for Medicare & Medicaid Services (CMS).

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

LICENSE FOR USE OF PHYSICIANS’ CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION (“CPT”)

End User Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2019 American Medical Association. All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the American Medical Association (AMA).

You, your employees and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza, 330 Wabash Ave., Suite 39300, Chicago, IL 60611-5885. Applications are available at the AMA Web site, http://www.ama-assn.org/go/cpt.

Applicable FARS\DFARS Restrictions Apply to Government Use. Please click here to see all U.S. Government Rights Provisions.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with (INSERT NAME OF PROVIDING ENTITY) or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

LICENSE FOR USE OF CURRENT DENTAL TERMINOLOGY (CDT^TM)

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. By clicking below on the button labeled “I accept”, you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement.

If you do not agree with all terms and conditions set forth herein, click below on the button labeled “I do not accept” and exit from this computer screen.

If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. As used herein, “you” and “your” refer to you and any organization on behalf of which you are acting.

Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org/.
Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use. Please click here to see all U.S. Government Rights Provisions.
Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license.
ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for software, including any CDT and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement.

The ADA is a third party beneficiary to this Agreement.
CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS disclaims responsibility for any liability attributable to end user use of the CDT. CMS will not be liable for any claims attributable to any errors, omissions, or other inaccuracies in the information or material covered by this license. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled “I Accept”. If you do not agree to the terms and conditions, you may not access or use software. Instead you must click below on the button labeled “I DO NOT ACCEPT” and exit from this computer screen.

“The American Hospital Association (“the AHA”) has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.”

LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE (NUBC)

American Hospital Association Copyright Notice

Copyright © 2020, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at (312) 893-6816.

Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816 or Laryssa Marshall at (312) 893-6814. You may also contact us at ub04@healthforum.com.

American Hospital Association Disclaimer

Any reproduced portion of the American Hospital Association’s (AHA) Data Specifications Manual or Specifications Data (NUBC UB-04 codes) must include the following AHA disclaimer language in a prominent manner acceptable to the AHA: “The American Hospital Association (“the AHA”) has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

NUBC UB-04 TERMS and CONDITIONS

Reproduction of Text
The reproduction of the UB-04 Manual will follow the text exactly.
Headings, Illustrations, or Captions
No changes will be made in headings, illustrations, or captions.
No Deletions
No deletions will be made about without specific permission.
Reproduction Prohibitions and Limitation
The CMS user will not reproduce the entire NUBC UB-04 Specifications Manual, an entire chapter of the Specifications Manual, or any excerpt in excess of 10% of an entire chapter.
Use Authorized
CMS may use the Licensed Data and Manual for training and educational purposes, claims review and validation, and hospital billing analysis along with other CMS Agency purposes only which shall be limited to responding to inquiries related to proper coding.
NUBC UB-04 Specifications Data - Any Use Not Authorized is Prohibited
Any use not authorized is prohibited. Prohibitions include:
1. Making copies of the Specifications Data for resale or licensing;
2. Transferring copies of the Specifications Data to any party not bound by the CMSAHA data license agreement;
3. Creating modified or derivative works of the Specifications Data; and
4. Making any commercial use of the Specifications Data.
Use of the Specifications Data within the U.S.
The CMS user may use NUBC UB-04 data in programs administered by the Centers for Medicare & Medicaid Services within the U.S. and its territories.
Obscuring AHA Copyright
The CMS user shall not remove or obscure any AHA copyright notice or other proprietary rights notices included in AHA materials.
Rights Restrictions of DFAR
The CMS user acknowledges the Federal Acquisition Regulations (DFAR) restricts the U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation.
Disclaimer of Responsibility
The CMS user acknowledges the sole responsibility for NUBC UB-04 Specifications Data is with CMS or its Medicare/Medicaid authorized agents. No endorsement by the AHA is intended or implied. The AHA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.
Questions about the Data License
Any questions pertaining to the license or use of the NUBC UB-04 Data will be addressed to the AHA. The CMS user will submit AHA use-related inquiries to the CMS_CPT_CDT_NUBC_Mailbox for submission to the AHA-designated CMS contact.

FOR PROPRIETARY CODES:

This material contains content from LOINC® (http://loinc.org). The LOINC table, LOINC codes, and LOINC panels and forms file are copyright © 1995-2019, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and available at no cost under the license at http://loinc.org/terms-of-use.

FOR NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA) MEASURES:

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). The HEDIS measures and specifications are owned and copyrighted by NCQA. Users of the HEDIS measures and specifications shall not have the right to alter, enhance or otherwise modify the HEDIS measures and specifications, and shall not disassemble, recompile, or reverse engineer the HEDIS measures and specifications. Anyone desiring to use or reproduce the materials without modification for the purpose of Health Homes Core Set reporting may do so without obtaining any approval from NCQA. All other uses, including a commercial use (including but not limited to vendors using the measures and specifications with a product or service to calculate measure results), must be approved by NCQA and are subject to a license at the discretion of 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 also makes no representations, warranties or endorsements about the quality of any organization or clinician who uses or reports performance measures. NCQA has no liability to anyone who relies on HEDIS measures and specifications or data reflective of performance under such measures and specifications.

Limited proprietary coding is contained in the measure specifications 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. The American Medical Association holds a copyright to the CPT® codes contained in the measure specifications. The American Hospital Association holds a copyright to the Uniform Billing Codes (UB) contained in the measure specifications.

NCQA Measure Certification Notice:

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 unadjusted HEDIS specifications, may not be called a “Health Plan 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 “Uncertified, Unaudited Health Plan HEDIS Rates.”

FOR THE CMS SCREENING FOR DEPRESSION AND FOLLOW-UP PLAN MEASURE:

The Screening for Depression and Follow-up Plan measure was developed by Quality Insights, Inc. as a special project under the Quality Insights' Medicare Quality Improvement Organization (QIO) contract HHSM-500-2005-PA001C with the Centers for Medicare & Medicaid Services. This measure is in the public domain.

Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Quality Insights, Inc. disclaims all liability for use or accuracy of any Current Procedural Terminology (CPT^®) or other coding contained in the specifications. CPT^® contained in the Measure specifications is copyright 2004-2017 American Medical Association. All Rights Reserved. This performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.

THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

FOR THE USE OF PHARMACOTHERAPY FOR OPIOID USE DISORDER MEASURE:

The Use of Pharmacotherapy for Opioid Use Disorder (OUD) measure was developed by Mathematica under the Quality Measure Development and Maintenance for Centers for Medicare & Medicaid Services (CMS) Programs Serving Medicare-Medicaid Enrollees and Medicaid-Only Enrollees contract HHSM-500-2013-13011I, Task Order #HHSM-500-T0004.

For Proprietary Codes:

Limited proprietary coding is contained in the measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications. Professional organizations frequently update their codes. Code lists for calculation of this measure were accurate as of April 2019.

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.

Level II HCPCS codes in these specifications are approved and maintained jointly by the Alpha-Numeric Panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association.)

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 at http://opendatacommons.org/licenses/odbl/1.0/. Any rights in individual contents of the database are licensed under the Database Contents License at http://opendatacommons.org/licenses/dbcl/1.0/

FOR THE PHARMACY QUALITY ALLIANCE (PQA) MEASURES:

PQA, Inc. retains all rights of ownership to the PQA measure specifications and value sets and can rescind or alter the measures at any time. No use of any PQA measure is authorized without prior PQA approval of such use. All uses of PQA measures are subject to such conditions as PQA specifies, and certain uses of the measures may be subject to a licensing agreement specifying the terms of use and the licensing fee. Users of the measure shall not have the right to alter, enhance, or otherwise modify the measures.

By agreeing to this statement, user accepts the following limitations of the use of the PQA measures: User acknowledges that the PQA measure specifications and value sets will only be used for the sole purpose of reporting state data on Medicaid and CHIP Core Set measures to CMS and will not be used for other purposes. Except for the purpose indicated above, the PQA measure specifications and value sets will not be used in any other commercial product, service, or value-added benefit. User also acknowledges that the PQA value sets will not be forwarded or provided to anyone outside of their organization.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled “ACCEPT”. If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled “DO NOT ACCEPT” and exit from this computer screen.