Copyright © 2020 National Committee for Quality Assurance. To receive this award, WRAAA was required to demonstrate strong performance of the functions outlined in the NCQA Standards for Accreditation of Case Management for LTSS. Share this page with a friend or colleague by Email. Explaining NCQA Health Plan Accreditation (HPA) Series. Use evidence-based standards to perform a gap analysis and determine improvement areas: Demonstrate the quality of your organization’s programs. Faculty will also facilitate short activities to simulate how to address requirements. 1 Overview of the NCQA Credentialing Standards Presentation for NAMSS Conference By: Veronica C. Locke September 20, 2016 Objectives/Agenda •Review how to read a standard. NCQA Case Management Accreditation is for organizations that provide a broad range of case management services for complex and high-risk populations: 1. Standards help plans in: Quality Management and Improvement. We do not share your information with third parties. This OnDemand event provides a focused and thorough examination of the HPA Standards for Delegation (DEL). Perform functions covered in the accreditation program or arrange for the functions to be performed, directly or through a service agreement. 2. NCQA accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of HEDIS, the tool the nation Each program helps organizations improve their operations and initiatives in targeted areas and demonstrate their commitment to quality. 3. Develop personalized, patient-centered care plans. Manage valid sample size of individuals for NCQ… NCQA Case Management Accreditation provides a framework for implementing evidence-based best practices to ensure: Save your favorite pages and receive notifications whenever they’re updated. 2017 Standards Concepts 21 Care Management and Support Care Coordination and Care Transitions Performance Measurement & Quality Improvement Identifying patients for care management Person-centered care plan development Management of lab/imaging results Tracking and managing patient referrals Care transitions Collecting and analyzing performance data Setting goals Improving practice … The updated standards combine important components of population health management such as wellness and complex case management, which were long-standing NCQA Accreditation requirements. Visit the Distinction in Multicultural Health Care section for more information. NCQA offers a Long-Term Services and Supports (LTSS) Distinction for organizations who provide case management services and coordinate social services for LTSS. Knowledge of URAC, NCQA, or CM standards of practice. Deliver a broad range of case management services for complex or high-risk populations. Organizations must meet program criteria to pursue the accreditation. Benefits of NCQA Case Management Accreditation . Uses up-to-date evidence-based information to develop its case-management program, and regularly updates the program with relevant findings and information. Find information about NCQA LTSS Distinction here: 1. Multicultural Health Care identifies organizations that lead the market in providing culturally and linguistically sensitive services, and working to reduce health care disparities. ILS has been NCQA-accredited for Case Management for LTSS since 2017. Maintenance of Continuing Education appropriate to care management and renewal of any certifications Demonstrated accountability and skills in analysis, decision making, time management and oral, written communication Familiarity with available resources that include any applicable regulations, reimbursement guidelines, community … “Case Management Accreditation moves us closer to measuring quality across population health management initiatives,” said Margaret E. O’Kane, President, NCQA. Demonstrate to partners and clients (e.g. NCQA Case Management Accreditation requirements ensure that organizations can consistently use efficient and cost-effective case management processes and delivery of services. It’s important for organizations to coordinate services effectively among caregivers, individuals, LTSS providers and clinicians. NCQA offers a Distinction in Multicultural Health Care that identifies organizations—health plans, MCOs, MBHOs, wellness and population health organizations, and others—that lead the market in providing culturally and linguistically sensitive services, and working to reduce health care disparities. Explaining HPA Standards for Delegation (DEL) OnDemand. LTSS Distinction can support your organization in achieving these goals. 2017 Case Management Standards and Guidelines Effective for surveys with a start date of January 30, 2017 - June 30, 2020. Patient Identification and Assessment. NCQA accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of HEDIS, the tool the nation Perform functions covered in the accreditation program or arrange for the functions to be performed, directly or through a service agreement. NCQA is a non-profit organization dedicated to improving health care quality. Use patient-centered assessment to determine care needs. Case management is a vital part of the health care delivery system. Required Standards for NCQA Case-Management Accreditation. May 15th, 2020. As the population ages, more states are seeking to increase accountability, improve quality and promote a cost-effective service delivery system that integrates care across all services—medical, behavioral, social and LTSS. The application process for Accreditation, Certification and Distinction is now managed through My.NCQA. You will be prompted to log in to your NCQA account. Patient monitoring to track care-goal progress. Terms of Use, Patient-Centered Specialty Practice (PCSP), Credentials Verification Organization (CVO), Managed Behavioral Healthcare Organization (MBHO), Health Information Technology Prevalidation Programs, Virtual Seminars, Webinars and On-demand Training, Contractual Services (Quality Solutions Group), Advertising and Marketing Your NCQA Status, Distinction in Multicultural Health Care section. Many public health experts are advocating for rapidly scaling up the use of community health workers as part of the COVID response. Explaining HPA Standards for Utilization Management (UM) OnDemand . Use patient-centered assessment to determine care needs. Press release. Read about NCQA's Case Management (CM) program here. Terms of Use, Patient-Centered Specialty Practice (PCSP), Credentials Verification Organization (CVO), Managed Behavioral Healthcare Organization (MBHO), Health Information Technology Prevalidation Programs, Virtual Seminars, Webinars and On-demand Training, Contractual Services (Quality Solutions Group), Advertising and Marketing Your NCQA Status. This Case Management publication outlines standards and features explanations and examples of how to meet the standards, scoring guidelines, points and certification outcomes. Provide access to qualified case management staff. Helps ensure plans have a cohesive plan of action for addressing member needs across the continuum of care. Standards and Guidelines:The complete standards and guidelines, including the intent and scope of review. ILS has been NCQA-accredited for Case Management for LTSS since 2017. On July 15, 2020, NCQA awarded Western Reserve Area Agency on Aging Accreditation of Case Management for Long-term Services and Supports (LTSS) for 3 years. Long-Term Services and Supports Distinction evaluates NCQA-Accredited case management organizations that coordinate LTSS and want to demonstrate they have the processes to effectively deliver person-centered care. Systematically identifies patients who qualify for its programs. This … Care Planning. The new PHM category also recognizes the important role of data analytics for identifying population needs, targeting resources to the right individuals and evaluating the impact of their strategy. NCQA Case Management Accreditation evaluates organizations performing case management services that typically focus on patients who are at high risk of experiencing costly hospitalizations or poor health outcomes because of complex social, behavioral or medical needs. Looking for the Application Packet for This Product? NCQA Accreditation standards are intended to help organizations achieve the highest level of performance possible and create an environment of continuous improvement. Care Management; NCQA Panel to Create Standards for Community Health Worker Profession. NCQA Standards Veronica C. Locke, MHSA October 24, 2017 Standard statement Statement about acceptable performance or results Intent statement Sentence describing importance of standard Summary of changes Changes from year to year. Faculty will walk participants through a detailed explanation of each Credentialing standard and lead participants through scenarios that are designed to mimic real-life credentialing scenarios. Develop personalized, patient-centered care plans. This Case Management publication outlines standards and features explanations and examples of how to meet the standards, scoring guidelines, points and certification outcomes. Faculty will equip participants with tips for interpreting the requirements, navigating the standards, and avoiding common misconceptions. Also NCQA recognition may be pivotal to future Medicare programs like the complex care management … 4. Introduction to NCQA Credentialing Standards. “Achieving NCQA accreditation again for Case Management for LTSS is a testament to the work we do every day to serve the needs of vulnerable, frail and aging populations nationwide,” said Nestor Plana, Chairman/CEO of ILS. If DHCS were to align with those requirements, the expectations and requirements of MCPs could potentially align with other agencies such as Covered California, and further reduce redundancies for the MCPs.