FAQ Directory: Accreditation of Case Management for LTSS (LTSS-only Plans)

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9.15.2025 Semiannual reporting and evaluation requirements if delegates are NCQA-Accredited and Certified Are NCQA-Accredited or Certified delegates required to provide semiannual reporting to organizations and are organizations required to evaluate semiannual reports from NCQA-Accredited or Certified delegates?

No. Effective immediately, organizations receive automatic credit for the delegation agreement semiannual reporting requirement and delegation oversight semiannual report evaluation requirements in Elements A and C, when an NCQA-Accredited or Certified delegate performs an NCQA-required activity. For example, UM 12, Element A, factor 3 and UM 12, Element C, factor 4 do not apply to a delegate that is NCQA-Accredited or Certified.

If a delegate is no longer NCQA-Accredited or Certified, the organization must immediately begin evaluating semiannual performance reports from the delegate.

CM_LTSS 2026