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

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12.15.2018 Mutually Agreed-Upon Dates in the Delegation Contract What date on the delegation agreement is considered the “mutually agreed-upon” date?

NCQA considers the implementation date as the date when the delegate can start performing delegated activities. But because the organization and delegate may have mutually agreed on and implemented delegated activities before signing the delegation agreement, NCQA is changing the policy for evidence of the implementation date.

When reviewing a delegation agreement, NCQA will consider the effective date or start date specified in the agreement as the mutually agreed-upon implementation date, for Element A (of the delegation standards), factor 1. This date may be before or after the signature date on the delegation agreement. If the agreement does not contain an effective date/start date, NCQA considers the date when the agreement was signed as the mutually agreed-upon implementation date.

NCQA may also accept other evidence of the implementation date: a letter, meeting minutes or other form of communication between the organization and the delegate that references their agreement on the delegated activity start date.

If an organization references the effective date/start date of the delegation agreement as the implementation date, NCQA will require submitted evidence for all other delegation factors to conform to that date as the implementation date.

The language in the explanation will be updated in a future Policy Update for applicable 2019 publications.

HP 2019

10.15.2018 80% must-pass threshold for UM elements Because NCQA raised the UM must-pass threshold from 50% to 80%, will NCQA create an 80% scoring option for requirements without such a scoring option?

No. To keep scoring simple, NCQA set a threshold of 80% or higher for all UM must-pass elements, rather than setting a specific threshold for each element based on its scoring options. If an element does not have an 80% option, the “or higher” applies. Keep in mind that an organization may miss the requirements for a few files and still score 100% on the element. For additional information on file review scoring, refer to the scoring table in each element or to the file review worksheet in the Interactive Review Tool (IRT).

HP 2019

9.15.2018 Life-planning activities for Complex Case Management (CCM) Policies and Assessment Are organizations required to address life-planning activities at the first contact and start of the CCM initial 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.

HP 2019

9.15.2018 Data collection for prevention programs for behavioral healthcare for QI 6, Element A, factor 5 For QI 6, Element A, factor 5, are organizations required to have implemented a preventive behavioral healthcare program in order to meet the factor?

No. Element A does not require organizations to implement a preventive behavioral healthcare program. The intent of factor 5 is that organizations collect data to determine if there are behavioral health issues that could be prevented if a program were to be implemented. Organizations collect data to meet Element A. Identifying the opportunity for such a program and implementing it is applicable to Element B.

HP 2019

9.15.2018 Level of Analysis Required for Appointment Accessibility Does the organizational analysis in NET 2, Element A need to be stratified by practitioner type?

No. NCQA does not require the analysis to be stratified by practitioner type.

HP 2019

9.15.2018 Revised Look-back Period for UM 7, Elements C, F, I (factors 2 and 3) In the 2019 HPA Standards and Guidelines, NCQA added a fifth bullet to the factor 2 Explanation and revised the factor 3 Explanation in UM 7, Elements C, F and I. Will NCQA give organizations a grace period for the added information in factors 2 and 3 of UM 7, Elements C, F and I?

The intent of the added language in factors 2 and 3 was to clarify the minimum information required for expedited appeals. NCQA recognizes these are new requirements, and for this reason, has added the following language to the scope of review:

Organizations must implement the changes in factors 2 and 3 for files processed on or after 11/1/18.

NCQA will post an update in December for the 2019 HP publication to reflect this change.

HP 2019

9.15.2018 Terminated arrangements more than 90 calendar days before submission 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?

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.

HP 2019

8.29.2018 What is the Health Plan Medicaid Module?

NCQA Health Plan Medicaid Module is a complementary program designed to support NCQA-Accredited health plans with a Medicaid product line. The combination of the module standards and NCQA Health Plan Accreditation maximize alignment with the Medicaid Managed Care program requirements. This improves a plan’s opportunity to receive a streamlined state compliance review.

NCQA developed the module by analyzing changes to state and federal requirements for the Medicaid Managed Care programs, as outlined in the Medicaid Managed Care Rule.

HP 2020

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 What is the process for earning LTSS Distinction for Health Plans?

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

See a step-by-step process.

HP 2020

8.24.2018 Where can I find information to help me get started with Health Plan Accreditation?

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