NCQA’s New Accreditation and Distinction Programs Improve Quality of Long-Term Services and Supports

July 25, 2016

WASHINGTON, DC—As part of its mission to improve quality in health care, the National Committee for Quality Assurance (NCQA) is offering new accreditation and distinction programs to assess organizations responsible for coordinating long-term services and supports (LTSS). NCQA is releasing its Accreditation of Case Management for LTSS and LTSS Distinction requirements for health plans, managed behavioral health organizations (MBHO) and community-based organizations (CBO) on July 25. Surveys will begin in January 2017.

What Are LTSS?

LTSS include a broad range of supportive services (e.g., help bathing, shopping, cooking) that people may need when they experience difficulty completing self-care tasks as a result of aging, chronic illness or disability. Services are delivered in institutional, home and community-based settings. They create a person-driven support system and help millions of Americans live more independent lives by allowing them to remain in their preferred setting—often, their home and community.

“Accreditation of Case Management for LTSS moves us closer to measuring quality across population health management initiatives,” said Margaret E. O’Kane, President, NCQA. “Not only does it add value to existing quality improvement efforts; it also demonstrates an organization’s highest level of commitment to improving the quality of care that meets people’s needs.”

About LTSS

• Nationwide, about 11 million adults 18 and older receive LTSS.
• Demographic trends suggest considerable growth in the number of Americans who will need LTSS in the coming decades.
• Medicaid is the primary payer for both institutional and community-based LTSS.
• Medicaid programs are increasingly moving to coordinated or “managed” models of LTSS.

LTSS Accreditation and Distinction: How Do They Differ?

NCQA Accreditation of Case Management for LTSS is for community based-organizations and other organizations coordinating LTSS.

NCQA LTSS Distinction supports NCQA-Accredited health plans and MBHOs in demonstrating their ability to effectively coordinate LTSS in addition to physical and behavioral health services.

LTSS Accreditation and Distinction Program Benefits

Create a standardized roadmap for health plans and MBHOs to coordinate delivery of high-quality care, directly or through CBOs.

Give CBOs that are unfamiliar with managed care a framework for understanding its processes.

Support state regulatory oversight and contracting expectations for MCOs and CBOs.

LTSS best practices academy

NCQA is launching the LTSS best practices academy. Starting in January 2017, the academy will be a forum for discussing challenges and sharing best practices in delivering and coordinating LTSS.

NCQA would like to thank Preferred Population Health Management (PPHM) as the exclusive sponsor of the academy, supporting ongoing learning and development associated with improving the coordination of LTSS. Thanks to the generous support of PPHM, early adopters of the LTSS evaluation will be able to participate in the academy for free and other CBOs will have the opportunity to participate at a significantly reduced cost.

Early Adopters

Thirty organizations will be among the first in the country to be evaluated under the new LTSS program requirements. This includes organizations from across 14 states, 5 health plans and an array of CBOs including area agencies on aging, aging and disability resource centers, home and community-based service organizations and others.

Additional Support

The SCAN Foundation and John A. Hartford Foundation provided early support for the development of LTSS requirements by funding a learning collaborative for CBOs and health plans to ensure the standards are appropriate for organizations coordinating LTSS.