Accreditation of Case Management for LTSS
States and MCOs need assurance that their partners can coordinate care effectively across medical, behavioral and social services to help keep individuals in their preferred setting—often, their home and community.
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.
- 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.
Improve Operational Efficiencies
Standards are based on industry best practices. A focus on coordinated care, training and measurement can help organizations reduce errors and duplicated services.
Better Care Integration
Standards can help organizations improve communication between individuals, caregivers, providers,
payers and other organizations that coordinate care.
Better Care Planning and Monitoring
Standards focus on person-centered services, which can lead to better care planning and monitoring.
Support Contracting Needs
Standards align with the needs of states and MCOs.
NCQA-Accredited organizations demonstrate their readiness to be trusted partners in coordinating LTSS services.