NCQA Announces New HEDIS Volume for Organizations Providing LTSS

As part of its mission to improve quality and create standards in health care, the National Committee for Quality Assurance (NCQA) is introducing a new set of Healthcare Effectiveness and Data Information Set (HEDIS®) measures that assess whether organizations providing or coordinating Medicaid long-term services and supports (LTSS) are delivering high-quality, person-centered care. The HEDIS Technical Specifications for LTSS Organizations create performance standards, allow comparison of LTSS quality across programs, and establish national benchmarks.

The measures will be included in the HEDIS 2019 Technical Specifications for LTSS Organizations ePublication available on September 12, 2018. To pre-order these specifications, go to the NCQA Store website.

NCQA and Mathematica developed and tested the measures under a contract with the Centers for Medicare & Medicaid Services (CMS).

The set of four measures evaluates quality of assessment, care planning, and care coordination for organizations providing LTSS:

• LTSS Comprehensive Assessment and Update
• LTSS Comprehensive Care Plan and Update
• LTSS Shared Care Plan with Primary Care Practitioner
• LTSS Reassessment/Care Plan Update After Inpatient Discharge

LTSS include a range of supportive services that people may need—for weeks, months or years—when they have difficulty completing self-care tasks because of aging, chronic illness, or disability. The goal of LTSS is to establish a support system that provides people with choice, control and access to services that ensure optimal outcomes, such as independence, health, and quality of life. These services are vital in helping millions of Americans live more independent lives by allowing them to remain in their preferred setting—often, their home and community.

Historically, LTSS has been delivered under a fee-for-service system. However, under new federal waivers, states are entrusting LTSS coordination and management to managed care plans. The delivery of LTSS through capitated managed care programs is called managed long-term services and supports (MLTSS).

Despite the rapid growth in LTSS, evaluation of LTSS quality is siloed by state-specific quality programs that do not permit the development of national benchmarks for quality or comparison across state Medicaid programs. Similarly, no HEDIS measures address the quality of LTSS care, even though many MLTSS plans report HEDIS measures as part of state requirements or Medicaid Health Plan Accreditation.

“We are proud to partner with Mathematica Policy Research and CMS to produce this set of national measures that will improve the care that organizations provide to the frail and elderly,” said Margaret E. O’Kane, President, NCQA. “With these measures we can compare organizations using standards to evaluate their services, ensuring good quality care throughout the country.”

“We are excited to make the first set of nationally standardized MLTSS quality measures available to state Medicaid agencies and MLTSS health plans, and are grateful for the advice and support they offered throughout the development and testing process,” said Debra Lipson, a senior fellow at Mathematica.

The latest version of the MLTSS Quality Measures Technical Specifications along with additional information about MLTSS can be found on Medicaid.gov.