URAC Medicaid with LTSS Accreditation — Frequently Asked Questions

Last updated: April 2026

Answers to the questions IHS most commonly receives from Medicaid managed care organizations preparing for — or evaluating — URAC Medicaid with Long-Term Services and Supports Accreditation.

What is URAC Medicaid with LTSS Accreditation?

URAC Medicaid with Long-Term Services and Supports (LTSS) Accreditation is a specialized program for Medicaid managed care organizations that serve members requiring long-term care assistance due to aging, chronic illness, or disability. It combines URAC's core Medicaid Health Plan standards with an LTSS-specific module covering person-centered care planning, LTSS care coordination, community integration, HCBS compliance, LTSS network adequacy, and quality measurement for long-term care populations. URAC launched this program in November 2021 as part of a full redesign of its health plan accreditation portfolio.

How is URAC Medicaid with LTSS different from standard URAC Medicaid Health Plan Accreditation?

Standard URAC Medicaid Health Plan Accreditation evaluates a plan's overall quality management, utilization management, network adequacy, member rights, and regulatory compliance for a general Medicaid population.

URAC Medicaid with LTSS Accreditation includes all of those core standards plus an LTSS module that addresses the distinct needs of members who receive home- and community-based services, nursing facility care, personal care attendant services, and other long-term supports. The LTSS module adds standards for person-centered care planning, LTSS-specific care coordination, community integration and HCBS settings compliance, LTSS provider network adequacy, and quality metrics specific to long-term care outcomes.

Who should pursue URAC Medicaid with LTSS Accreditation?

Any Medicaid managed care organization participating in a state Managed Long-Term Services and Supports (MLTSS) program should evaluate this accreditation. More than 24 states contract with MCOs to deliver LTSS through capitated managed care arrangements. Organizations serving members with intellectual/developmental disabilities, physical disabilities, or dual Medicare-Medicaid eligibility are also strong candidates.

Plans seeking to qualify for or retain MLTSS state contracts, differentiate in competitive procurements, or demonstrate quality to CMS should consider the LTSS-specific program rather than standard Medicaid Health Plan accreditation.

What does the LTSS module cover that standard accreditation does not?

The LTSS module adds standards in six primary areas:

• Person-centered care planning — individualized care plans developed with active member participation, reflecting goals, preferences, and functional needs alongside clinical needs
• LTSS care coordination — coordinated management across home- and community-based service providers, nursing facilities, primary care, and behavioral health
• Community integration and HCBS settings compliance — active management of transitions and community placement goals consistent with federal HCBS settings requirements
• LTSS network adequacy — network standards that account for personal care attendants, adult day programs, home health agencies, skilled nursing facilities, and supported employment providers
• Grievance and appeals specific to LTSS — processes tailored to service hour reductions, provider terminations, and transition disputes
• LTSS quality measurement — metrics aligned with CMS MLTSS quality measures including falls risk screening, care planning assessments, successful transitions, and community integration rates

How long does URAC Medicaid with LTSS Accreditation take?

The full cycle from initial gap analysis through accreditation decision typically runs 12 to 18 months. URAC's updated program has reduced document upload requirements by more than 50%, shortening preparation compared to earlier versions.

The binding constraint is not documentation assembly — it is operational lead time. URAC reviewers evaluate evidence generated over a sustained period, not policies assembled the week before submission. Organizations standing up new LTSS program infrastructure require more lead time than those with mature LTSS operations that need compliance gap remediation.

What states recognize URAC accreditation for Medicaid managed care requirements?

URAC fulfills state health plan accreditation requirements in 15 states: Arkansas, Connecticut, Florida, Iowa, Michigan, Minnesota, Montana, North Dakota, New Jersey, New Mexico, Nevada, Oklahoma, Texas, Utah, and Vermont. Organizations operating in these states may be able to satisfy state licensing or contracting accreditation requirements through URAC Medicaid with LTSS Accreditation. State requirements vary — contact IHS or the applicable state agency for current requirements in your market.

What are the most common gaps organizations have when preparing for URAC Medicaid with LTSS Accreditation?

The most common LTSS-specific gaps IHS identifies:

• Person-centered care plans that are templated rather than genuinely individualized — plans that do not reflect member goals, functional priorities, or cultural values in documented form
• Care coordination siloed by service type — medical care managed separately from HCBS services with no documented integration mechanism
• HCBS settings compliance documentation gaps — plans that have not conducted or documented required settings assessments
• Network adequacy files that account only for clinical providers, omitting LTSS-specific provider types such as personal care attendants and adult day programs
• Quality reporting infrastructure that tracks HEDIS measures but lacks LTSS-specific outcome metrics required by the module
• Grievance and appeals processes not adapted for LTSS-specific dispute types including service hour reductions and provider terminations

How much does URAC Medicaid with LTSS Accreditation cost?

URAC does not publicly publish application or survey fees for its Medicaid with LTSS Accreditation program. Fees are customized based on organization size and scope. Contact URAC directly for a fee quote. IHS consulting engagement fees are scoped per client engagement — Schedule a Free Discovery Session for a tailored proposal.

What is MLTSS and how does it relate to this accreditation?

Managed Long-Term Services and Supports (MLTSS) refers to the delivery of LTSS through capitated Medicaid managed care programs, where states contract with MCOs to provide both LTSS and standard Medicaid benefits under a single managed care arrangement. As of 2024, more than 24 states operate MLTSS programs — up from just 8 states in 2004.

URAC Medicaid with LTSS Accreditation is designed for MCOs operating in this model. The LTSS module standards are directly aligned with MLTSS operational requirements: person-centered planning, HCBS settings compliance, LTSS provider network management, and CMS MLTSS quality measures.

What is the accreditation cycle length?

URAC health plan accreditation cycles are typically two to three years. Contact URAC directly for the current cycle length specific to the Medicaid with LTSS program, as URAC periodically updates cycle lengths as part of program revisions. IHS tracks current program parameters and can advise on cycle length as part of an initial consultation.

Can a plan hold both URAC Medicaid with LTSS and NCQA Medicaid Health Plan Accreditation?

Yes. URAC and NCQA are separate accrediting bodies. A plan can hold both simultaneously. Dual accreditation is increasingly common among large Medicaid MCOs operating across multiple states with different accreditation requirements. URAC accreditation does not substitute for NCQA accreditation, and vice versa. IHS consults on both programs.

What does URAC review during a Medicaid with LTSS Accreditation survey?

URAC's review process includes a documentation review evaluating policies, procedures, evidence uploads, meeting minutes, and reports — followed by a validation review that may include interviews with organizational leadership and staff. For the LTSS module, reviewers specifically evaluate care plan files for person-centeredness and individualization, care coordination documentation demonstrating cross-service integration, network files for LTSS-specific provider types, grievance and appeals case files, and quality reporting documentation for LTSS-specific metrics.

URAC's updated program has reduced document upload requirements by more than 50%, but the scope of what is evaluated has not been reduced.

What happens if URAC issues an RFI during our review?

A Request for Information (RFI) means URAC reviewers need additional documentation or clarification before completing their evaluation. RFIs have defined response windows. Failure to respond within the window — or responses that do not address the specific deficiency identified — can result in conditional findings or denial.

IHS provides RFI response support as part of accreditation engagements: we review the RFI, identify the root gap, draft the response with supporting evidence, and ensure the response addresses the reviewer's actual concern rather than the surface question.

Does IHS have experience with URAC Medicaid with LTSS specifically?

IHS is led by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC. That background provides direct knowledge of how URAC standards are developed, interpreted, and applied in review — knowledge that extends to the LTSS module standards. IHS consults on the full portfolio of URAC health plan accreditation programs, including Medicaid with LTSS, standard Medicaid Health Plan, and commercial health plan programs.