FAQ Directory: Long-Term Services and Supports (LTSS)

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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.

8.20.2018 What other organizations have earned LTSS Accreditation?

Over forty organizations have earned NCQA Accreditation of Case Management for LTSS. See the NCQA Report Card for a directory of accredited organizations.

8.20.2018 What is Accreditation of Case Management for LTSS?

NCQA Accreditation of Case Management for LTSS is a comprehensive, program designed to support organizations that coordinate LTSS. 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 and MCO requirements.

8.20.2018 Where can I find information to help me get started with LTSS Accreditation?

8.20.2018 How does this Accreditation help my organization?

Earning NCQA’s 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 needs of states and MCOs. NCQA-Accredited organizations demonstrate that they’re ready to be trusted partners in coordinating LTSS services.

8.20.2018 What organizations are eligible?

Organizations in operation for at least 6 months and coordinate LTSS are eligible for accreditation; for example:

  • Area Agencies on Aging.
  • Aging and Disability Resource Centers.
  • Centers for Independent Living.
  • Other home and community-based organizations.
  • Health plans that coordinate LTSS that do not provide medical/behavioral health benefits.
  • Case management organizations.
  • Other organizations that coordinate LTSS.

NCQA-Accredited MBHOs or health plans that offer comprehensive medical benefits and manage LTSS are not eligible for this accreditation but can earn LTSS Distinction.

8.20.2018 What is the process for earning Accreditation?

The first step to earning accreditation 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 accreditation status within 30 days of the final review.

See a step-by-step process.

8.20.2018 Where can I find the LTSS Accreditation Standards and Guidelines?

8.20.2018 How-do-I-get-started-with-LTSS-Accreditation?

How do I get started with LTSS Accreditation?

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.

8.20.2018 How long does it take to earn Accreditation?

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.