Long-Term Services and Supports (LTSS)

CMS Guidance:

  • Home and Community-Based Settings Toolkit. (Centers for Medicare & Medicaid Services/March 2014) This toolkit is designed to assist states in complying with new requirements in the recently published home and community-based services (HCBS) regulations.
  • Medicaid Home and Community-Based Services (HCBS) Final Rule. (Centers for Medicare & Medicaid Services/January 2014) These regulations detail requirements for states in providing Medicaid HCBS and may also apply to integrated care initiatives for Medicare-Medicaid enrollees that rely on Medicaid authorities subject to these requirements.

General Background on LTSS:

  • Rising Demand for Long-Term Services and Supports for Elderly People (Congressional Budget Office/July 2013). This report provides data and examines the financing of long-term services and supports, the functional and cognitive limitations of seniors in the community, where services are being provided, and possible scenarios for the future of long-term services and supports.
  • Medicaid Home and Community-Based Service Programs: 2009 Data Update (Kaiser Family Foundation/December 2012). This report summarizes the key trends in expenditures and participation data for Medicaid Home and Community-Based Services (HCBS) programs – (1) the mandatory home health services state plan benefit, (2) the optional personal care services state plan benefit, and (3) optional § 1915(c) HCBS waivers services.
  • Medicaid and Long-Term Care Services and Supports (Kaiser Family Foundation/June 2012). This updated fact sheet provides an overview of long-term care services, delivery of such services, and the large role Medicaid plays in financing long-term care.

Managed Care:

  • Resources for Integrated Care This website, developed under contract to the Medicare-Medicaid Coordination Office, supports health plans and providers to deliver more integrated, coordinated care to Medicare-Medicaid enrollees, especially those individuals with intellectual and developmental disabilities, physical disabilities, and serious mental illness.
  • Consumer Direction in Managed Long-Term Services and Supports Programs (Integrated Care Resource Center/March 2013). In this webinar, a speaker from the National Resource Center for Participant-directed Services explains participant direction and how it can be included in contract language, then staff from the Arizona Health Care Cost Containment System give an example of how Arizona implemented consumer direction in its long-term care system (ALTCS).
  • People with Disabilities and Medicaid Managed Care: Key Issues to Consider (Kaiser Family Foundation/February 2012). This issue brief examines issues in the development and implementation of managed care programs for Medicaid beneficiaries with disabilities, particularly policy considerations related to setting rates, developing provider networks and delivery systems, and ensuring sufficient beneficiary protections and plan oversight.

Provider Network:

Capitation Rate Setting:

  • Medicaid Rate-Setting Strategies to Promote Home- and Community-Based Services (Center for Health Care Strategies/May 2012). This policy brief describes rate development strategies that states can use to promote home- and community-based services (HCBS) in MLTSS programs, the role of integrated care programs to help expand HCBS, and other considerations for developing rates for MLTSS programs.

Uniform Assessment:

State-Specific Resources:

  • Managed Long Term Care: Options for New York and Examples from Other States (Mathematica Policy Research/July 2011). This presentation to the New York Managed Long Term Care Implementation and Waiver Redesign Work Group outlines options for combining Medicaid acute and long-term care services for Medicaid-only beneficiaries and options for including Medicare services for dual-eligible beneficiaries.

Quality Measurement:

  • Measuring HCBS Quality in MLTSS Programs (National Council on Aging/September 2013) This webinar highlighted efforts in two states implementing new Medicaid managed long-term services and supports (MLTSS) programs and focused on: (1) findings from an external evaluation in Illinois tracking the transition to MLTSS and consideration of home and community-based services measures as the program integrates LTSS; and (2) how New York is planning to measure outcomes in its new MLTSS program for individuals with intellectual and developmental disabilities.
  • Introduction to Quality Measures in Managed Long-Term Services and Supports (National Council on Aging, Friday Morning Collaborative/February 2012). This webinar provides an introduction to world of quality measurement. It will provide an overview of NCQA (National Committee on Quality Assurance), HEDIS (Healthcare Effectiveness Data and Information Set), and CAHPS (Consumer Assessment of Healthcare Providers and Systems).

MFP and ACA Opportunities: