California’s public health care systems have been working for years to strengthen and expand their ambulatory care systems, providing improved access to primary and specialty care to their patients, in a more timely and patient-centered manner. A robust ambulatory care system serves as the foundation of any high-performing integrated system of care
Ambulatory care redesign also plays a critical role in the Medi-Cal 2020 waiver’s cornerstone programs, which provide financial incentives to shift the focus away from hospital-based and inpatient care, towards outpatient, primary and preventive care.
To support this system transformation, SNI’s activities are using in-person meetings and focused webinars to help members strengthen three primary care building blocks: empanelment, team-based care, and population management. SNI’s Ambulatory Care Redesign program uses the six required projects in the PRIME program (Integration of Physical and Behavioral Health, Primary Care Redesign, Specialty Care Redesign, Improved Perinatal Care, Care Transitions, and Complex Care Management for High Risk Medical Populations) as case studies for improvement.
Approval to use both PRIME and QIP Reporting Manuals and associated code sets
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AMA Copyright Statement
The five character codes included in the PRIME Reporting Manual DY14 and the QIP Reporting Manual for PY 2 Year End Reporting are obtained from Current Procedural Terminology (CPT®), copyright 2018 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures.
The responsibility for the content of PRIME Reporting Manual DY14 and the QIP Reporting Manual for PY 2 Year End Reporting is with SNI and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in PRIME Reporting Manual DY14 and the QIP Reporting Manual for PY 2 Year End Reporting. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Any use of CPT outside of PRIME Reporting Manual DY14and the QIP Reporting Manual for PY 2 Year End Reporting should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. CPT is a registered trademark of the American Medical Association.
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION (“CPT®”)
CPT only copyright 2018 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
You, your employees and agents are authorized to use CPT only as contained in the PRIME Reporting Manual DY14, and QIP Program Year 2 Reporting Manual - solely for your own personal use and only for participating in state governmental healthcare related programs supported by and/or administered by SNI. You acknowledge that the American Medical Association (“AMA”) holds all copyright, trademark and other rights in CPT.
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 American Medical Association, Intellectual Property Services, AMA Plaza, 330 North Wabash Avenue, Suite 39300, Chicago, Illinois 60611-5885. Applications are available at the American Medical Association Web site (http://info.commerce.ama-assn.org/ama-data-file-request-0).
U.S. Government Rights
This product includes CPT which is commercial technical data, which was developed exclusively at private expense by the American Medical Association (AMA), 330 North Wabash Avenue, Chicago, Illinois 60611. The AMA does not agree to license CPT to the Federal Government based on the license in FAR 52.227-14 (Data Rights - General) and DFARS 252.227-7015 (Technical Data - Commercial Items) or any other license provision. The AMA reserves all rights to approve any license with any Federal agency.
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. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with SNI, 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 product.
This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
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Pharmacy Quality Alliance Copyright Statement
By agreeing to this policy, user accepts the following limitations of the PRIME and QIP use of the Pharmacy Quality Alliance (PQA) Opioid measures and code sets: To accurately calculate the measure rates, the PQA NDC files are required. User acknowledges that the PQA measures and NDC files will only be used for the sole purpose of evaluating and improving opioid use for populations being served by Public Health Care Systems (PHS) and by District and Municipal Hospitals (DMPH) and will not be used for other purposes within user. Except for the purpose indicated above, the measures and NDC file will not be used in any other commercial product, service or value-added benefit. User also acknowledges that the information and lists will not be forwarded or provided to anyone outside of SNI, the California Department of Health Care Services DHCS, the PHS or the DMPH.
PQA retains the rights to these measures and can rescind or alter the measures at any time. PQA may approve an organization’s use of the measures; however, no organization may use the measures without first obtaining permission from PQA prior to using the measures. Certain uses of the measures are only approved with a licensing agreement from PQA that specifies the terms of use and the licensing fee. PQA reserves the right to determine the conditions under which it will approve use and/or license the measures. Users of the measure shall not have the right to alter, enhance, or otherwise modify the measures.
