Long-term Services and Supports Distinction for Case Management Organizations Requirements
NCQA Long-term Services and Supports Distinction for Case Management Organizations evaluates organizations that provide comprehensive clinical case management services and coordinate social services for long-term services and supports (LTSS) populations.
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. Organizations 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.
- Qualifications and assistance for LTSS providers. Organizations have a process for checking paid provider background and qualifications and offer access to assistance to deliver services.
To see all program requirements, get the Standards & Guidelines document.
IS MY ORGANIZATION ELIGIBLE?
An organization is eligible for the NCQA LTSS Distinction if:
- It has a current NCQA Accreditation status, or
- Is seeking NCQA Case Management Accreditation.
Note: NCQA conducts LTSS Distinction Surveys at the legal-entity level.
LTSS DISTINCTION FOR CASE MANAGEMENT ORGANIZATION RESOURCES
Find information about NCQA LTSS Distinction 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.