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FAQ Directory: Long-Term Services and Supports Distinction for Health Plans

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8.24.2018 What other organizations have earned Health Plan Accreditation?

Over 1,000 health plan products have earned NCQA Health Plan Accreditation. See the NCQA Report Card for a directory of accredited organizations.

HP 2020

8.24.2018 Where can I find the Medicaid Module Standards and Guidelines? How can I obtain the Medicaid Module Standards and Guidelines?

8.24.2018 What is the price for Health Plan Accreditation?

Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.

HP 2020

8.24.2018 How does the LTSS Distinction for Health Plans 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, 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 state needs. NCQA-Accredited organizations demonstrate that they’re ready to be trusted partners in coordinating LTSS services.

HP 2020

8.24.2018 How does the Medicaid Module help my organization?

Meeting NCQA Medicaid Module standards can help organizations:

  • Streamline compliance activities. Compliance activities are reduced when the state uses NCQA Health Plan Accreditation and Medicaid Module standards as part of the Medicaid quality review.
  • Become more efficient. Reallocate key quality review resources to other Medicaid priorities.

HP 2020

8.24.2018 How long does it take to earn Health Plan 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.

HP 2020

8.24.2018 What is Long-term Services and Supports Distinction for Health Plans?

NCQA LTSS Distinction for Health Plans is a complementary program designed to support health plans coordinating 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 requirements.

HP 2020

8.24.2018 Where can I find information to help me get started with the Medicaid Module?

8.17.2018 Where can I find information to help me get started with the LTSS Distinction?

8.15.2018 Updated: Use of Acronyms in UM Denial and Appeal Notices In UM 7, Elements B, E and H and UM 9, Element D, the explanation under Factor 1: states that the reason for denial should not include abbreviations or acronyms that are not defined. Similar language is in UM 8 A.
Does this mean that they must be spelled out (e.g., “We are denying your request for a deoxyribonucleic acid (DNA) test because…”) or explained (“We are denying your request for a DNA test, which is a test that looks at your genetic information in order to…”), or both?

The intent of the requirement is that the denial or appeal notice be written in language that can be easily understood by members. Because abbreviations/acronyms may include terms that are not easily understood, even when spelled out, they must be explained. NCQA is updating the explanation under each applicable factor of the referenced elements to read:

The denial [appeal] notification states the reason for the denial [upholding the denial] in terms specific to the member’s condition or request and in language that is easy to understand, so the member and practitioner understand why the organization denied the request [upheld the denial] and have enough information to file an appeal.
 
An appropriately written notification includes a complete explanation of the grounds for the denial, in language that a layperson would understand, and does not include abbreviations, acronyms or health care procedure codes that a layperson would not understand. The organization is not required to spell out abbreviations/acronyms if they are clearly explained in lay language. Denial [Appeal] notifications sent only to practitioners may include technical or clinical terms.
 

NCQA will post an update in December for the 2018 and 2019 HP and UM-CR-PN and 2018 MBHO publications to reflect this change.

HP 2019

7.15.2018 Medical necessity review for personal care services Does NCQA require medical necessity review for personal care services, such as cooking, cleaning and transportation?

No. Medical necessity review is not required for personal care services and other activities of daily living in UM 4–UM 7. However, if these services are covered benefits, any denial decision may be appealed and is included in the scope of appeal file review for UM 9.

HP 2018

5.15.2018 MED standards and the new Medicaid module The previous MED standards are now 15 standards. Can you explain what happened?

In March, NCQA released an expanded Medicaid Module, a voluntary set of 15 standards for organizations with a Medicaid product line. This new module both incorporated the original MED standards (MED 1-MED 6) and added 10 new standards to align with provisions in the federal Medicaid Managed Care Final Rule released by CMS in April 2016.

The new MED module applies to only 2018 HPA; therefore, HPA survey tools for 2017 and earlier are unaffected and do not include the new Medicaid module.

HP 2018