Accreditation of Case Management for LTSS-only Health Plans Requirements

The standards are a roadmap for improvement—organizations can use the standards to perform a gap analysis and align their improvement activities in the areas that are most important to individuals and states.

FOCUS AREAS TO ENSURE HIGH QUALITY

NCQA’s 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.

The program evaluates organizations in areas such as:

• Conducting comprehensive assessments.
• Managing care transitions.
• Performing person-centered assessments.
• Planning and managing critical incidents.
• Measurement and quality improvement.

To see all program requirements, get the Standards & Guidelines document.

IS MY ORGANIZATION ELIGIBLE?

Health plans that coordinate LTSS and do not provide medical/behavioral health are eligible for this accreditation.

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.

ACCREDITATION OF CASE MANAGEMENT FOR LTSS RESOURCES

Find information about NCQA Accreditation of Case Management for LTSS here:

• 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.