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

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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

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 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

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 Where can I find the Medicaid Module Standards and Guidelines? How can I obtain the Medicaid Module Standards and Guidelines?

8.24.2018 What is Long-term Services and Supports Distinction for Health Plans?

NCQA LTSS Distinction for Health Plans is a complementary program designed to support health plans coordinating LTSS. The program 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.

HP 2020

8.24.2018 What is the process for meeting Module requirements?

The first step 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 provides results within 30 days of the final review.

See a step-by-step process.

HP 2020

8.24.2018 How long does it take to earn Health Plan Accreditation?

The typical evaluation time frame is 12 months from application submission to decision, depending on an organization’s readiness. Some organizations may already be working within NCQA guidelines.

HP 2020

8.24.2018 What organizations are eligible for the Medicaid Module?

An organization is eligible for the NCQA Health Plan Medicaid Module if:

  • Its Medicaid product line has a current NCQA Accreditation status as a First or Renewal Survey, or
  • It is seeking accreditation for its Medicaid product line under NCQA HP Accreditation as an Interim, First or Renewal Survey.

HP 2020

8.24.2018 What other health plans have earned LTSS Distinction?

8.24.2018 What is the price for Health Plan Accreditation?

Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.

HP 2020

8.24.2018 What is the price for the LTSS Distinction for Health Plans?

Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.

HP 2020