Accreditation of Case Management for Long-Term Services and Supports Standards

NCQA’s standards provide a framework for organizations to deliver efficient, effective person-centered care that meets people’s needs, helps keep people

in their preferred setting and aligns with state and MCO requirements.

Program Requirements

NCQA Accreditation of Case Management for LTSS evaluates organizations in eight standard areas. They include:



Program description.

Organizations use up-to-date evidence and professional standards to develop their case management programs, and regularly update programs with emerging findings and information.


Assessment process.

Organizations systematically assess the populations they serve and have a process for conducting comprehensive assessments.


Person-centered care planning

and monitoring.

Organizations have a process for developing individualized care plans that incorporate personal preferences, prioritized goals and self-management plans, and monitor progress against those plans.


Care transitions.

Organizations have a process for managing transitions, identifying problems that could cause unplanned care transitions and, when possible, preventing unplanned transitions.


Measurement and quality

improvement.

Organizations measure and work to improve participant experience, program effectiveness and active participation rates.


Staffing, training and verification.

Organizations define staffing needs, verify staff credentials, when applicable, and provide ongoing staff training and oversight.


Rights and responsibilities.

Organizations communicate the rights and responsibilities

of participants in a case management program.


Delegation.

Organizations document and monitor functions performed for them by other organizations.

 

Getting Accredited

Obtaining accreditation usually takes between nine and twelve months, depending on your organization’s readiness. The accreditation process follows a consistent series of steps.

Become a trusted organization for coordinating long-term services and supports. Contact an NCQA representative to learn more about the program, or purchase the Accreditation of Case Management for LTSS standards.