Last updated: April 2026
URAC Health Plan with LTSS Accreditation — Frequently Asked Questions
URAC Health Plan with Long-Term Services and Supports (LTSS) Accreditation is a structured quality recognition program for health plans that manage care for members with long-term care needs. The questions below address the program requirements, process, timeline, costs, and common challenges — drawn from IHS's direct experience guiding health plans through this accreditation.
What is URAC Health Plan with LTSS Accreditation?
URAC Health Plan with Long-Term Services and Supports (LTSS) Accreditation is a third-party quality recognition program for health plans that serve members who require ongoing personal care, home- and community-based services, or institutional long-term care. It combines URAC's core Health Plan Accreditation standards with an LTSS-specific module covering person-centered assessment, care planning, care coordination, and LTSS quality management. URAC accredits organizations — it does not certify individual professionals or guarantee coverage approvals.
Who needs URAC Health Plan with LTSS Accreditation?
This accreditation is primarily pursued by Medicaid managed care organizations (MCOs) administering LTSS benefits under state contracts, dual-eligible (Medicare-Medicaid) plans that coordinate care across payer boundaries, commercial health plans with home health or long-term care benefit lines, and integrated managed care plans that bundle physical health, behavioral health, and LTSS under one benefit structure. Many state Medicaid programs require or strongly prefer health plan accreditation as a condition of contract award or renewal.
What is the difference between URAC Health Plan Accreditation and Health Plan with LTSS Accreditation?
URAC Health Plan Accreditation covers the core operational standards for any health plan — governance, consumer protection, quality management, network management, utilization management, and health information. The Health Plan with LTSS Accreditation adds an LTSS-specific module on top of those core standards, covering LTSS program structure, comprehensive functional assessment, person-centered care planning, care coordination for LTSS populations, and LTSS-specific quality management. Organizations that manage LTSS benefits need the combined program; organizations without LTSS lines of business typically pursue the core Health Plan program only.
How long does URAC Health Plan with LTSS Accreditation take?
From the decision to pursue accreditation to receiving a final decision, plan for approximately 12 to 18 months. This includes: application and program selection (1–2 months), gap analysis and policy development (2–4 months), policy implementation and evidence building including the operational track record period URAC requires (3–6 months), application preparation and URAC desktop review with revisions (1–3 months), and the survey, committee review, and final decision (2–4 months). Organizations that begin with significant policy and infrastructure gaps typically need the longer end of this range.
What does URAC's accreditation process involve?
URAC's accreditation process has four main stages. First, the organization submits an application and uploads required documentation. Second, URAC conducts a desktop review — typically 30 to 45 days — in which reviewers evaluate submitted policies, procedures, and evidence against each standard and issue clarification requests. Third, URAC surveyors conduct structured interviews with organizational leaders and operational staff and may review case files or observe operations. Fourth, the application is presented to URAC's Accreditation Committee, which meets twice a month; organizations are notified of the decision within 10 business days.
What are the key LTSS module standards?
The LTSS module in URAC's Health Plan Accreditation v8.0 includes: LTSS 1–3 (LTSS program structure, leadership, and resources), LTSS 4 (comprehensive assessment — covering functional status, medication review, member input, and available community resources), LTSS 5 (person-centered care plan — including care plan features, additional care plan elements, and ongoing care plan management), LTSS 4–5 (assessing coordination needs and care coordination workflows), and LTSS 6 (LTSS program quality management — outcomes measurement and continuous improvement specific to LTSS populations).
What is person-centered planning and why does URAC require it?
Person-centered planning is an approach to care coordination in which the member — and, where appropriate, their caregivers and support network — drives the development and ongoing management of their care plan. URAC requires person-centered planning in its LTSS module because LTSS populations are particularly vulnerable to care that is driven by system convenience rather than member need. Standard LTSS 5 specifies detailed requirements for how care plans are developed, what they must contain, who participates in the process, and how they are updated over time.
What are the most common gaps organizations have when pursuing this accreditation?
The most common gaps IHS encounters include: absence of a formal documented LTSS program with defined leadership accountability; functional assessment tools that do not capture all elements URAC requires, particularly medication review and available community resources; care plans that are provider-driven rather than member-driven; care coordination workflows that exist operationally but are not documented in policy to URAC's required level of specificity; LTSS quality management programs that track generic health plan metrics rather than LTSS-specific outcomes; and delegation oversight gaps for community-based service providers contracted to deliver LTSS.
How much does URAC Health Plan with LTSS Accreditation cost?
URAC does not publicly disclose its fee schedule. Contact URAC directly at businessdevelopment@urac.org for current application and accreditation fees applicable to your organization's size and structure. IHS consulting engagement fees are scoped per engagement — contact us for a proposal tailored to your organization's starting point, timeline, and scope.
Can URAC Health Plan with LTSS Accreditation satisfy state Medicaid requirements?
Many state Medicaid programs accept URAC health plan accreditation as evidence of quality compliance, and some require it as a condition of managed care contract award or renewal. Specific requirements vary by state. Before selecting an accreditation program, IHS recommends confirming with your state Medicaid agency which accrediting bodies and which program variants satisfy your specific contract requirements.
What is Interim Accreditation and does URAC offer it for Health Plan with LTSS?
URAC offers an Interim Accreditation designation for organizations that meet the core standards but have not yet demonstrated the full operational track record required for full accreditation. Interim accreditation can be used to satisfy state requirements during the period an organization is building its compliance history. Organizations should confirm with URAC and their state Medicaid agency whether interim status satisfies their contractual accreditation requirements.
What changed in the 2021–2022 URAC health plan program restructuring?
In November 2021, URAC unveiled a restructured suite of health plan accreditation programs, including the Health Plan Accreditation v8.0 with Long-Term Services and Supports Module and the Medicaid Health Plan with LTSS Accreditation. These programs replaced earlier versions and consolidated LTSS-specific standards into a more cohesive module structure. The 2025–2026 update further streamlined the application process, reducing required document uploads by more than 50% while maintaining standards rigor.
What is the difference between URAC Health Plan with LTSS and URAC Medicaid with LTSS Accreditation?
URAC Health Plan with LTSS Accreditation applies to health plans generally — including commercial plans and Medicaid plans. URAC Medicaid with LTSS Accreditation is specifically designed for Medicaid managed care plans and includes Medicaid-specific standards covering state contract compliance, Medicaid regulatory requirements, and Medicaid-specific consumer protections. Organizations that operate exclusively in Medicaid should evaluate whether the Medicaid-specific program better aligns with their regulatory environment and state contract requirements.
Why should I use a consultant for URAC Health Plan with LTSS Accreditation?
URAC accreditation requires organizations to demonstrate compliance with dozens of standards across both core health plan operations and an LTSS-specific program — simultaneously, and with documented operational evidence. Organizations that attempt accreditation without consulting support frequently encounter mid-process surprises: gaps in functional assessment tools, care plan documentation that does not meet URAC's specificity requirements, or delegation oversight structures that fail desktop review. A consultant with direct URAC institutional experience reduces revision cycles, shortens timelines, and significantly improves first-cycle accreditation outcomes. IHS engagements are led by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC.