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Key Elements Managed Long Term Services Cheat Sheet (DRAFT) by [deleted]

This is a draft cheat sheet. It is a work in progress and is not finished yet.


Delivery system reforms continue to play a role in shaping state Medicaid programs, partic­ularly with regard to benefi­ciaries who require long term services and supports. An increasing number of states in the US are using managed long term services and supports (MLTSS) as a strategy for expanding home- and commun­ity­-based services. The use of these services, which are provided through capitated Medicaid managed care programs, has been shown to enhance the quality and improve the efficiency of care.


Managed Long Term Care (MLTC)

A system that stream­lines the delivery of long-term services to people who are chroni­cally ill or disabled and who wish to stay in their homes and commun­ities. These services, such as home care or adult day care, are provided through managed long-term care plans that are approved by the State Department of Health. The entire array of services to which an enrolled member is entitled can be received through the MLTC plan the member has chosen.

Long­-term services and supports (LTSS)
Encomp­asses a range of paid and unpaid medical and personal care assistance that people may need when they experience difficulty completing self-care tasks as a result of aging, chronic illness, or disabi­lity.

Long-term services and supports provide assistance with activities of daily living and instru­mental activities of daily living. Long-term services and supports include, but are not limited to, nursing facility care, adult daycare programs, home health aide services, personal care services, transp­ort­ation, and supported employment as well as assistance provided by a family caregiver.

Care planning and care coordi­nation services help benefi­ciaries and families navigate the health system and ensure that the proper providers and services are in place to meet benefi­cia­ries’ needs and prefer­ences; these services can be essential for LTSS benefi­cia­ries.

Element of MLTC

1. Adequate Planning and Transition Strate­gies. Older adults often rely on networks to meet all needs: basic daily, planning for future care and incorp­orating strategies for transi­tional care into the MLTSS are important.
2. Stakeh­older Engage­ment. All stakeh­olders, including patients, health care providers, and payers, must be given opport­unities to provide input on the MLTSS program in order for it to be effective.
3. Enhanced Provision of Home-Based and Commun­ity­-Based Servic­es. Take into account the key questions of what the indivi­dual’s goals and prefer­ences are be when providing home/c­omm­uni­ty-­based services, in order to ensure that these goals and prefer­ences are being met.
4. Alignment of Payment Structures with MLTSS Progra­mmatic Goals. In the last few years, many states have worked to better align their Medicaid payment structures with the goals of the MLTSS program. For example, having a single rate for instit­utional care and home- and commun­ity­-based care can provide an incentive for people to stay in the community, because this would result in a lower total cost for commun­ity­-based care.
5. Support for Benefi­cia­ries. Some of the current proposals highli­ghted by Kayala included having mandatory indepe­ndent choice counseling and advocacy support for people receiving MLTSS. These services would be provided indepe­ndently of the managed care entities so that an individual can get a broader range of options.
6. Person­-ce­ntered Proces­ses. Frequently heard from patient advocates are concerns that MLTSS must be more person­-ce­ntered to be effective.
7. Compre­hensive & Integrated Service Package. Ideally, MLTSS will evolve to integrate LTSS with other health care needs on order to provide a broader and more compre­hensive range of services. Health experts must look at the big picture and work with other stakeh­olders to optimize that integr­ation.
8. Qualified Provid­ers. The qualif­ica­tions required of the health care provider will depend on the indivi­dual's needs. Therefore, having a standard set of requir­ements for providers may not be the best strategy.
9. Partic­ipant Protec­tio­ns. CMS expects states will address vulner­abi­lities through program design, contracts with approp­riate health and welfare assura­nces, a strong critical incident management system, and an appeals process that allows access to contin­uation of services while an appeal is pending.
10. Quality. A quality MLTSS program includes both existing LTSS quality systems and managed care quality systems

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