Long-term Services and Supports Distinction for Health Plans Requirements

NCQA Long-term Services and Supports Distinction for Health Plans evaluates organizations that provide medical and behavioral services and coordinate long-term services and supports (LTSS). 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. Your organization must meet the eligibility criteria to pursue the accreditation.

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.

Core areas of focus drive organizational effectiveness and efficiency:

  • Person-Centered Care Planning. Organizations must have a process for developing individualized care plans that incorporate individuals’ preferences, goals and self-management plans.
  • Care Transitions. Organizations must have a process to effectively manage and support individuals during transitions of care and reduce unplanned transitions.
  • Coordination of Services. Coordinate care and services for individuals who have complex needs and multiple providers, to close gaps in care.
  • Critical Incident Management System. Organizations have a system to promptly report, track and follow up on incidents such as abuse, neglect and exploitation.

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

IS MY ORGANIZATION ELIGIBLE?

An organization is eligible for the NCQA LTSS Distinction for a product/product line if:

  • The product/product line has a current NCQA Accreditation status, or
  • The product/product line is seeking NCQA Health Plan Accreditation.

Note: NCQA conducts LTSS Distinction Surveys at the legal-entity level. Organizations undergoing Interim Survey are not eligible for LTSS distinction.

Health plans that coordinate LTSS and do not provide medical or behavioral services are not eligible for this distinction but can earn Accreditation of Case Management for LTSS.

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.
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