Long-Term Services and Supports Distinction for Health Plans

The consequence of this expansion is that organizations must be able to demonstrate that they can coordinate LTSS between caregivers, individuals, providers and clinicians; implement person-centered care planning and effective care transitions across care settings; and support people living optimally in their preferred setting.

To operate at this high level, health plans must have core functions in place, such as person-centered care planning and critical-incident management systems with built-in health equity principles and patient protections.

NCQA’s LTSS Distinction supports health plans that provide managed health services and coordinate social services for LTSS. Program standards can help organizations meet state needs, close quality gaps and support the best care, regardless of setting.

A QUALITY IMPROVEMENT FRAMEWORK

LTSS standards provide a framework for organizations to deliver effective, person-centered care that meets people’s needs, helps keep people in their preferred setting and aligns with state requirements.

Core areas of focus drive organizational effectiveness and efficiency:

• Person-Centered Care Planning.
• Care Transitions.
• Coordination of Services.
• Critical Incident Management System.
• Qualifications and Assistance for LTSS Providers.

New standards for 2024 deliver even more support to organizations committed to high-quality, equitable care:

• Populations: Reflect the broad range of populations enrolled in LTSS programs, including people with disabilities, over 65+, intellectual/developmental disorders, disabilities, traumatic brain injury, acquired brain injury, serious mental illness, serious emotional disturbance, mental health/substance use disorder.
• Health Equity: Prioritizes commitment to improving health equity including the collection of demographic data, social needs, and prioritizing DEI in recruitment and hiring practices.
• Person-Centered Goals: Updated and expanded glidepath includes a standardized approach to tracking person-centered goals.
• Patient Protections: Verify that plans have an appropriate process for authorizing/denying service requests.
• Alternate Scoring for HEDIS LTSS Measures: Applicable in survey year 2023, allows MLTSS plans that receive an 80% performance threshold rate for reporting on the LTSS-CAU and LTSS-CPU measures to receive credit for LTSS 1, Element D: Comprehensive Assessment Implementation LTSS 1, Element G: Implementing the Care Planning Process in lieu of submitting file review evidence.

How does this Accreditation help my organization?

Earning NCQA Accreditation of Case Management for LTSS can help organizations:

• Become more efficient. A focus on coordinated care, training and measurement can help organizations reduce errors and duplicated services.
• Integrate care better. Standards can help organizations improve communication between individuals, caregivers, providers, payers and other organizations that coordinate care.
• Provide person-centered care. Standards focus on person-centered services, which can lead to better care planning and monitoring.
• Support contracting needs. Standards align with federal requirements for states. NCQA-Accredited organizations demonstrate that they’re ready to be trusted partners in coordinating LTSS services.

LTSS Distinction’s Value to States

Connects LTSS programs to nationally endorsed standards for delivery of coordinated, person-centered care and services.

Aligns with LTSS provisions in the Medicaid managed care rule and provides a framework to support reporting on key measures in CMS’s HCBS Quality Measure Set.

Reinforces state initiatives to integrate care and support improving outcomes for LTSS enrollees.

Expands the value of NCQA’s accreditation programs to cover high quality, equitable care for the LTSS population and help reduce administrative burden on state oversight.

Standardizes performance evaluation of the model of care for special needs plans coordinating long-term services and supports.

NCQA LTSS Distinction in Action

As of June 2023, nine states require their Medicaid plans to earn NCQA LTSS Distinction. States looking to maximize Accreditation add LTSS Distinction to their managed care contracts.