Long-Term Services and Support: New Quality Improvement Target

Long-Term Services and Support: NCQA Seeks Feedback

If you’re on one of the NCQA mailing lists, you know we just finished celebrating our 25th year pursuing better quality health care. Search 25 Years of Quality in the blog and you’ll find a long list of accomplishments. You’ll see the pursuit of new avenues for improving care is nothing, uh, new for us. So, perhaps this post will not be all that out of the ordinary.

It is, however, a bit extraordinary.

NCQA now intends to expand its expert evaluation efforts to include organizations responsible for the coordination of long-term services and supports (LTSS).

Various Profession Occupation Team Smiling Concept
The Public Comment Period is Open Until 5 P.M. ET, March 23, 2016

When delivered appropriately, long term services and support can help older Americans, and people living with disabilities lead happier, healthier lives.

“Millions of Americans rely on Long-term services and supports (LTSS) to help them live more independent lives,” said Patricia Barrett, NCQA vice president, Product Design and Support. “For many, LTSS represents a ticket to remain in the home and community.”

We know navigating the health care system can prove especially challenging for individuals who need LTSS. We also know 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.

So it has become all too clear organizations providing LTSS must implement best practices that best serve the people who need these services, consistently improve the quality of their services and help these Americans live independently.

The NCQA Way: A Call for Accountability

With that in mind, 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 into its Health Plan Accreditation (HPA) and Managed Behavioral Healthcare Organization Accreditation programs.

These proposed standards will improve care for individuals who need LTSS by requiring organizations to:

  • 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.

NCQA staff spent months consulting with LTSS providers, consumer advocates, payers and policy experts to draft proposed standards for accreditation. Now, it’s your turn to weigh in. The public is encouraged to share their thoughts on these proposals during NCQA’s public comment period.

How to Participate in Public Comment

Read and comment on the proposed changes here. The public comment period is open until 5 p.m. ET on March 23, 2016. Updated products will be released July 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.

NCQA thanks you in advance. We value your insight.

One thought on “Long-Term Services and Support: New Quality Improvement Target

  1. As a hospital Care Management leader, I am excited to see these new and higher expectations. Two comments:

    Regarding the proposed HEDIS measure for completing a revised care assessment AFTER hospital discharge, most of the time the assessment needs to be updated in order to faciliate discharge anyway. The prior assessment often does not support the patients cureent condition. I worry the State agencies will misinterpret this measure and REFUSE to update the assessment until after discharge. And the patient will be stuck in the hospital.

    Many times, the individual admits to the hospital because the client isn’t monitored often enough in the community to notice a client’s decline and adjust the care plan accordingly. We need standards for the frequency of putting “eyes on” the client while in Adult Family Homes and Assisted Living Facilities.

    Lastly, we really need long term care agencies to require their case managers to have their client’s identify a legal next of kin, or a health care decision maker, in writing. Many of these clients receive services initially at a time when they can make their own decisions. But, as time progresses, the client may no longer have decision making capacity. Then, they get sick and go to the hospital. Without a decision maker, the person gets stuck in the hospital.

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