No, include paid claims only (days denied for any reason should not be included) for all three of the rebalancing measures—LTSS Admission to an Institution from the Community, LTSS Minimizing Institutional Length of Stay, and LTSS Successful Transition after Long-Term Institutional Stay.
Should unpaid or denied claims be included in calculating the institutional utilization and rebalancing measures?
Date
Topic
Managed Long Term Services and Supports (MLTSS)
MLTSS Institutional rebalancing and utilization measures
FAQ ID
91111
FAQ Page
Managed Long Term Services & Supports FAQs
FAQ Question
Should unpaid or denied claims be included in calculating the institutional utilization and rebalancing measures?