FAQ Directory: Case Management

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3.15.2019 The explanation for LTSS 4, Element C, factor 1 states that analysis includes patterns of unplanned admissions, readmissions, emergency room visits and repeat visits, and admission to participating and nonparticipating facilities. Is the organization required to include all these areas to meet the intent of the factor?

LTSS 4, Element C: Analysis of Unplanned transitions

No. The organization is not required to include all these areas in its analysis, but at a minimum, must evaluate rates of unplanned admissions to facilities and emergency room visits to identify areas for improvement.

9.15.2018 Are organizations required to address life-planning activities at the first contact and start of the CCM initial assessment?

Life-planning activities for Complex Case Management (CCM) Policies and Assessment

No. After consideration, NCQA removed the requirement for case managers to address life-planning activities at the start of the initial assessment (first contact). This FAQ replaces the previous FAQ issued on October 15, 2017 (which has been deleted) regarding first contact, and the workbook has been adjusted to accommodate the change.

9.15.2018 If an organization terminated an arrangement with an NCQA-Accredited/Certified/Recognized delegate more than 90 calendar days before it submitted the completed survey tool, is the organization eligible for automatic credit for the portion of the look-back period when activities were performed by the delegate?

Terminated arrangements more than 90 calendar days before submission (CM and CMLTSS 2017)

Yes. For non-file review requirements, if the arrangement was terminated more than 90 calendar days before submission of the completed survey tool, the organization is eligible for automatic credit for the portion of the look-back period when the NCQA-Accredited/ Certified/Recognized delegate conducted activities. For file review requirements, automatic credit is applied if the delegate processed (or handled) the file, regardless of when the delegation arrangement was terminated.

8.24.2018 How long does it take to earn LTSS Distinction for Case Management Organizations?

The typical evaluation time frame is 12 months from application submission to decision, depending on an organization’s readiness. Some organizations may already be working within NCQA guidelines.

8.24.2018 Where can I find the LTSS Distinction for Case Management Organizations Standards and Guidelines?

Find the Standards and Guidelines document in the NCQA eStore.

8.24.2018 What is the price for the LTSS Distinction for Case Management Organizations?

Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.

8.24.2018 Where can I find information to help me get started with LTSS Distinction for Case Management Organizations?

Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation.
Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review.
Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organization’s survey readiness—the tool calculates your potential survey score.

8.24.2018 How does this LTSS Distinction help my case management 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 the state needs. NCQA-Accredited organizations demonstrate that they’re ready to be trusted partners in coordinating LTSS services.

8.24.2018 What is the process for earning LTSS Distinction for Case Management Organizations?

The first step to earning distinction is a discussion with an NCQA program expert. Purchase and review the program resources, conduct a gap analysis and submit your online application.

Align your organization’s processes with the standards. NCQA conducts the survey and determines your distinction status within 30 days of the final review.

See a step-by-step process.

8.24.2018 How do I get started with LTSS Distinction for Case Management Organizations?

If you are not currently accredited and want to learn more, contact NCQA. If you are currently accredited and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA.

8.24.2018 Are there additional resources for case management organizations seeking LTSS Distinction?

LTSS Best Practices Academy: Interactive forum for professionals to discuss strategies for coordinating quality long-term services and supports (LTSS) programs.
LTSS Roadmap: A compilation of resources to guide organizations through meeting Case Management and Health Plan Standards for LTSS.

8.24.2018 What is Long-term Services and Supports Distinction for Case Management Organizations?

NCQA LTSS Distinction for Case Management Organizations is a complementary program designed to support organizations that provide comprehensive clinical case management services and coordinate social services for LTSS populations. The program 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 requirements.