URAC Medicaid with LTSS Accreditation Consulting

Last updated: April 2026

URAC Medicaid with Long-Term Services and Supports (LTSS) Accreditation is the standard for managed care organizations delivering care to Medicaid members who need assistance with daily living due to aging, chronic illness, or disability. IHS provides full-cycle consulting — from initial gap analysis through accreditation decision — for health plans navigating both the core Medicaid standards and the LTSS-specific module requirements.

IHS is led by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC. That background shapes how we work: we know how URAC reviewers read documentation, what gaps generate deficiency findings, and where organizations consistently fall short in LTSS-specific standards.

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What Is URAC Medicaid with LTSS Accreditation?

URAC Medicaid with Long-Term Services and Supports (LTSS) Accreditation is a specialized health plan accreditation program designed for Medicaid managed care organizations that serve members requiring long-term care. Long-Term Services and Supports are defined as the broad range of paid and unpaid medical and personal care assistance that individuals may need — for weeks, months, or years — when they experience difficulty completing self-care tasks as a result of aging, chronic illness, or disability.

The program builds on URAC's standard Medicaid Health Plan Accreditation by adding an LTSS module with standards specific to this population. Where general Medicaid accreditation evaluates a plan's overall quality, the LTSS module evaluates how well the plan manages the distinct clinical, social, and functional needs of members who rely on home- and community-based services, nursing facility care, personal care attendants, and other long-term supports.

URAC launched this program in November 2021 alongside a full redesign of its health plan accreditation portfolio, recognizing that the explosive growth of Managed Long-Term Services and Supports (MLTSS) programs across the country created a need for a program standard that standard Medicaid Health Plan accreditation was not designed to address.

Who Needs URAC Medicaid with LTSS Accreditation

This program is relevant to any organization that:

  • Operates as a Medicaid MCO in an MLTSS state. More than 24 states have contracted with managed care plans to deliver LTSS through capitated arrangements. Plans in these states face increasing contractual and regulatory pressure to demonstrate quality through third-party accreditation.
  • Holds or is pursuing a state Medicaid MLTSS contract. Many state procurement requirements for MLTSS contracts now reference URAC or NCQA accreditation as a qualification criterion or scoring factor.
  • Serves populations with I/DD, physical disabilities, or dual-eligible status. Plans covering individuals with intellectual/developmental disabilities, physical disabilities, or those dually eligible for Medicare and Medicaid are prime candidates for the LTSS module.
  • Operates in one of the 15 states where URAC fulfills state health plan accreditation requirements. Arkansas, Connecticut, Florida, Iowa, Michigan, Minnesota, Montana, North Dakota, New Jersey, New Mexico, Nevada, Oklahoma, Texas, Utah, and Vermont recognize URAC accreditation as satisfying state licensing or contracting requirements.
  • Seeks market differentiation against competing MCOs. As state MLTSS programs mature, quality-based contracting is increasing. URAC accreditation with LTSS demonstrates to state agencies that a plan has been evaluated against an independent external standard specifically designed for this population.

What the LTSS Module Adds to Standard Medicaid Accreditation

URAC Medicaid with LTSS Accreditation combines the full core Medicaid Health Plan standards with an LTSS-specific module. The LTSS module addresses areas that standard Medicaid health plan accreditation does not cover in depth:

  • Person-Centered Care Planning. Standards require that care plans for LTSS members be developed with the member's active participation, reflect their goals, preferences, and cultural values, and address functional needs alongside clinical needs. Documentation must demonstrate genuine individualization — not templated plans.
  • LTSS-Specific Care Coordination. The plan must demonstrate coordinated management of LTSS services alongside medical care, including coordination between home- and community-based service providers, nursing facilities, primary care providers, and behavioral health. This is structurally different from standard care management for acute populations.
  • Community Integration and HCBS Compliance. Standards address the plan's role in supporting members' rights to live in the least restrictive setting, consistent with federal HCBS settings requirements under the ACA and CMS's 2014 Final Rule. Plans must demonstrate active management of transitions and community placement goals.
  • Network Adequacy for LTSS Providers. The plan's network standards must account for LTSS-specific provider types — personal care attendants, adult day programs, home health agencies, skilled nursing facilities, assisted living providers, and supported employment services — not just clinical providers.
  • Grievance and Appeals for LTSS Members. Standards recognize that LTSS members face distinct challenges — including appeals related to service hour reductions, provider terminations, and transition disputes — and require processes tailored to these situations.
  • Quality Measurement for LTSS Populations. The plan must establish and report quality metrics specific to LTSS outcomes, aligned with CMS MLTSS quality measures including falls risk screening, assessment and care planning, successful transitions after long-term facility stays, and community integration rates.

The core Medicaid standards — covering utilization management, network management, member rights, regulatory compliance, governance, and performance measurement — apply in full. Organizations pursuing URAC Medicaid with LTSS Accreditation must satisfy both layers.

How IHS Approaches URAC Medicaid with LTSS Accreditation Engagements

IHS structures URAC Medicaid with LTSS engagements in four phases. The phases are sequential by necessity — URAC reviewers evaluate evidence generated over time, not documentation assembled immediately before survey submission.

Phase 1: Gap Analysis

We conduct a standard-by-standard review of your current operations against both the core Medicaid standards and the LTSS module requirements. We map every gap to a remediation timeline and flag items that require operational lead time — policy changes must be implemented and generating evidence before the look-back window closes. Particular attention goes to LTSS-specific areas where organizations without dedicated LTSS compliance infrastructure routinely have gaps: person-centered care plan documentation, HCBS settings compliance evidence, LTSS network adequacy files, and quality measurement infrastructure for LTSS-specific metrics.

Phase 2: Policy and Documentation Development

IHS provides policy and procedure templates calibrated to current URAC standards. Your team adapts these to your specific operations and state contracts. We review all final documentation before submission. Templates cover person-centered care planning requirements, LTSS care coordination protocols, HCBS settings compliance procedures, LTSS-specific grievance and appeals processes, network adequacy methodology for LTSS provider types, and quality reporting frameworks for MLTSS measures.

Phase 3: Mock Review

Before you submit the application, IHS conducts a structured mock review simulating URAC's documentation review process. We audit care management files for LTSS-specific documentation requirements, test policy-to-practice alignment across LTSS standards, and identify gaps that would generate deficiency findings. Organizations that skip mock review consistently encounter avoidable RFIs and conditional findings.

Phase 4: Application Support and Post-Survey

IHS prepares the application, organizes evidence uploads, and supports your team through the URAC review process. If URAC issues Requests for Information (RFIs) or requests additional documentation, IHS drafts responses within the required windows. If the survey results in conditional findings, IHS prepares the corrective action plan and documentation.

Why Organizations Work with IHS on URAC Medicaid with LTSS

  • Principal-led by the former COO and General Counsel of URAC. Thomas G. Goddard, JD, PhD served as Chief Operating Officer and General Counsel of URAC before founding IHS. He has direct knowledge of how URAC standards are drafted, interpreted, and applied — knowledge that has no substitute.
  • LTSS-specific depth. Many accreditation consultants are generalists who apply the same framework to every health plan standard. IHS understands the structural differences between standard Medicaid managed care and MLTSS — including HCBS settings rules, CMS MLTSS quality measures, and state-specific MLTSS contract requirements that shape what URAC reviewers look for.
  • No fabricated benchmarks. IHS does not quote URAC application or survey fees because URAC does not publicly publish them. We do not invent market ranges. We refer you to URAC directly for fee information and scope our consulting engagement fees to your specific situation.
  • Efficient preparation. URAC's updated Medicaid with LTSS program reduces document upload requirements by more than 50% compared to prior versions. IHS aligns preparation to the current program requirements — not outdated checklists from earlier iterations.
  • State recognition expertise. URAC fulfills state health plan accreditation requirements in 15 states. IHS knows which states recognize URAC accreditation and how state-specific MLTSS contract requirements intersect with URAC's program standards.
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