If you are not currently accredited and want to learn more, contact NCQA. If you are currently accredited and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA.
HP 2020
FAQ Directory: Long-Term Services and Supports Distinction for Health Plans
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8.24.2018 How do I get started with the Medicaid Module?
8.24.2018 What organizations are eligible for Health Plan Accreditation?
- Operates under an insurance license (e.g., HMO, POS, PPO, EPO), and
- Issues a contract for insurance for a defined population or contracts with an employer to provide managed care services for a self-insured population, and
- Provides services through an organized delivery system that includes ambulatory and inpatient health care sites, and
- Performs functions addressed in the standards (quality improvement, care coordination, utilization management, credentialing, member rights and responsibilities), either directly or through a service agreement, and
- Has a process for monitoring, evaluating and improving the quality and safety of care provided to its members, and
- Reports audited HEDIS results for designated HEDIS measures and CAHPS ratings and composites, as required for the selected Evaluation Option.
HP 2020
8.24.2018 What is the process for earning Health Plan Accreditation?
The first step to earning accreditation 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 accreditation status within 30 days of the final review.
See a step-by-step process.
HP 2020
8.24.2018 How does Health Plan Accreditation help my organization?
- Use the NCQA Health Plan Accreditation standards to perform a gap analysis and determine improvement areas. They provide a framework for implementing evidence-based, best practices help plans improve in areas of:
- QI process.
- Population health management.
- Practitioner network and access to care.
- Utilization management processes.
- Credentialing and recredentialing processes.
- Members’ rights and responsibilities.
- Member connection.
- Medicaid service requirements.
- Satisfy state requirements and employer needs. The standards align with many state requirements.
HP 2020
8.24.2018 What is Health Plan Accreditation?
NCQA Health Plan Accreditation is the most widely recognized, evidence-based program in the industry dedicated to quality improvement and measurement. It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers. It’s the only evaluation program that bases results on actual measurement of clinical performance (i.e., HEDIS measures) and consumer experience (i.e., CAHPS measures).
HP 2020
8.24.2018 Are there additional resources for health plans seeking LTSS Distinction?
- LTSS Best Practices Academy: Interactive forum for professionals to discuss strategies for coordinating quality long-term services and supports (LTSS) programs.
- LTSS Roadmap: A compilation of resources to guide organizations through meeting Case Management and Health Plan Standards for LTSS.
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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.
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8.24.2018 Where can I find the Health Plan Accreditation Standards and Guidelines?
Find the Standards and Guidelines document in the NCQA eStore.
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
8.17.2018 Where can I find information to help me get started with the LTSS Distinction?
- Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation.
- 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.
HP 2020
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