Accreditation of Case Management for LTSS

NCQA CM-LTSS Accreditation standards are designed to help health care organizations navigate care coordination, integration of health equity principles and patient protections into care for vulnerable populations.

A QUALITY IMPROVEMENT FRAMEWORK

CM-LTSS standards provide a framework of continuous quality improvement for delivery of efficient, effective, person-centered care—care that meets individuals’ needs, helps keep them in their preferred setting and aligns with state requirements.

This Accreditation program evaluates organizations in a variety of areas:

• Critical-incident management systems.
• Communicating member rights and responsibilities.
• Quality measurement and reporting.
• Care transitions.

NCQA has survey options for different levels of organization readiness, to ensure multiple paths to success.

NEW AND ENHANCED STANDARDS AND FEATURES

• Updated scoring aligns with Health Plan Accreditation.
• An Interim Survey option for community-based organizations provides a glidepath to Accreditation.
• Updated standards reflect states’ expanding populations:
  • Persons with intellectual and/or developmental disabilities.
  • Children with disabilities.
  • Persons aged 65 and over.
  • Persons with serious mental illness.
  • Persons with traumatic brain injury.
  • Persons with acquired brain injury.
  • Persons with serious emotional disturbance.
  • Persons with mental health/substance use disorder.
• Updated standards align with NCQA’s Health Equity Accreditation programs and can confer automatic credit.
  • Prioritizes commitment to improving health equity including the collection of demographic data, social needs, and prioritizing DEI in recruitment and hiring practices.
• Revised standards language reflects prioritization of SMART, person-centered goals.
• Patient protections: Organizations must help members navigate benefit appeals.
• Organizations that demonstrate clinical integration and coordination with providers receive a designation on NCQA’s Report Card.

HOW CAN CM-LTSS 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 and providers, and 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 state needs. NCQA-Accredited organizations demonstrate their readiness to be trusted partners in coordinating LTSS services.

Organizations eligible for this Accreditation include:

• MLTSS-only health plans.
• CBOs.
• Area Agencies on Aging (AAA).
• Intellectual or Developmentally Disabled agencies.
• Adult Family/Foster Care agencies.
• Other human services organizations.

CM-LTSS ACCREDITATION’S VALUE TO STATES AND CBOS

States with managed care or FFS models can use CM-LTSS Accreditation to enhance the effectiveness of CBOs providing high-quality waiver services. For example:

• The Massachusetts Adult and Group Adult Foster Care Program requires participating providers to earn NCQA Accreditation.
• The Alabama Medicaid program supports AAAs’ pursuit of NCQA Accreditation to prepare them for managed care.
• Ohio requires AAAs to achieve CM-LTSS Accreditation.