NCQA invites the public to share comments on health care updates

ACCREDITATION PUBLIC COMMENTShare your comments by March 23, 2016

NCQA invites the public to comment on updates impacting Health Plan Accreditation, Case Management Accreditation and Managed Behavioral Health Organization (MBHO) Accreditation, as well as the introduction of a new Case Management Accreditation program for organizations providing Long-Term Services and Supports (LTSS).
PROVIDE FEEDBACKUpdates Involving Long-Term Services and Supports (LTSS)Long-term services and supports help older Americans, and those living with disabilities, live happier and healthier lives by providing access to services and quality care so they can remain independent in their homes and communities.

The fragmented nature of the delivery system is especially challenging for individuals needing LTSS because many require both medical care and LTSS. Effective coordination between clinicians, caregivers and providers in the community may reduce the need for acute medical care and prevent or delay nursing home placement, improving quality of life and reducing costs.

It is important that organizations providing LTSS implement best practices for person-centered care planning, effective care transitions and measuring quality improvement to support individuals living independently in the community.
NCQA is launching a new Case Management Accreditation program specifically geared towards organizations responsible for arranging LTSS. In addition, NCQA is integrating new requirements to better serve people receiving LTSS in its Health Plan Accreditation (HPA) and Managed Behavioral Healthcare Organization Accreditation programs. The proposed standards will deliver better care for vulnerable populations and will ensure that organizations in charge of delivering care:

  • Institute person-centered care planning. The individual using care and services controls activities surrounding care planning.
  • Manage care transitions. Organizations have a process to effectively manage transitions, support individuals during transitions and reduce unplanned transitions. 
  • Use a critical incident management system. Organizations have a dedicated system to promptly report, track and follow-up on incidents such as abuse, neglect and exploitation.
  • Coordinate services. Care and services are coordinated for individuals who have complex needs and multiple providers, and care gaps are closed.
  • Set qualifications for providers. Organizations set and verify qualifications and provide training and support to home- and community-based service providers.

Updates to Health Plan Accreditation, Case Management Accreditation for Clinical Programs and MBHO AccreditationNCQA is proposing retiring and evolving several standards from Health Plan Accreditation, MBHO Accreditation and the existing Case Management Accreditation program to reflect changes in how care is being delivered and to avoid duplication of federal regulations.

How to Participate in Public CommentRead and comment on the proposed changes online. The public comment period begins at 9 a.m. ET on February 24 and ends at 5 p.m. ET on March 23, 2016. Updated products will be releasedJuly 25, 2016. The Case Management program for organizations providing LTSS will be effective upon release. Changes to the existing HPA, MBHO and CM programs will be effective for the 2017 year.

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