Frequently Asked Questions are used to provide additional information and/or statutory guidance not found in State Medicaid Director Letters, State Health Official Letters, or CMCS Informational Bulletins. The different sets of FAQs as originally released can be accessed below.
Frequently Asked Questions
What if there are multiple Managed Long Term Services and Supports (MLTSS) LTSS Comprehensive Care Plan and Update care plans documented during the measurement period?
Use the most recently updated care plan.
What if a Managed Long Term Services and Supports (MLTSS) member refuses an LTSS Comprehensive Care Plan and Update care plan?
There must be documentation of the refusal, which would result in exclusion from the measure. The rate of exclusion due to a member refusing to participate should be reported along with the measure performance rate.
How should a Managed Long Term Services and Supports (MLTSS) member's refusal to sign an LTSS Comprehensive Care Plan and Update plan be documented?
To meet the LTSS Comprehensive Care Plan and Update measure numerator, the care plan must be signed by the member, unless the care plan is under appeal in the specified timeframe, and there is documentation that the care plan was in appeal. There is an exclusion for members who refuse to take part in care planning. This exclusion is reported with the measure rate, so the overall measure rate can be interpreted correctly. For example, a plan that is not successful at engaging members in care planning, indicated by a high exclusion rate, would suggest the overall rate on the measure should be interpreted with caution.
What if a Managed Long Term Services and Supports (MLTSS) member could not be reached for the LTSS Comprehensive Care Plan and Update?
There must be documentation that at least three attempts were made to reach the member, and they could not be reached. The rate of exclusion due to inability to reach a member should also be reported along with the measure performance rate.
What if a Managed Long Term Services and Supports (MLTSS) member either does not have a caregiver involved or does not want their caregiver involved in the LTSS Comprehensive Care Plan and Update? What if a member's caregiver declines to participate in care planning?
In these circumstances, MLTSS plan records should clearly document that no caregiver was involved to satisfy the measure criteria. For example, there are situations in which it may not be appropriate to engage the caregiver, including cases in which the member refused to involve the caregiver, or the invited caregiver declined to participate. Reasons for lack of caregiver involvement are not required; documentation that a caregiver was not involved suffices.
Does the Managed Long Term Services and Supports (MLTSS) LTSS Comprehensive Care Plan and Update measure account for how well MLTSS plans are addressing member goals identified in the care plan?
As a process measure, it is not designed to address the outcome of care planning—whether the services authorized by MLTSS plans and specified in the care plan meet members’ goals. One way to evaluate this outcome is through person-reported outcome measures reported through a survey or another method that asks individuals about their perspective on their care. Other measures and indicators, including those derived from the Consumer Assessment of Healthcare Providers and Systems Home and Community Based Experience of Care Survey and the National Core Indicators Aging and Disability Survey, can be used to help inform whether the services provided help individuals meet their goals.
If no deficit is identified for one of the core elements required for the care plan (for example, functional needs), what should the care plan contain?
For certain elements of the care plan, documentation of no deficit suffices to receive credit for the elements (for example, functional needs, medical needs, cognitive impairment needs). Other elements in the core and supplemental rates of the Managed Long Term Services and Supports (MLTSS) LTSS Comprehensive Care Plan and Update measure require documentation regardless of whether a deficit is identified (for example, individualized member goal, plan for follow-up and communication, plan for emergency). Refer to the details in the measure specification to identify where documentation of no deficit meets the element definition.
Must a Managed Long Term Services and Supports (MLTSS) member have a documented care plan to be eligible for the LTSS Shared Care Plan with Primary Care Practitioner (PCP) measure?
Yes, the denominator for this measure includes all MLTSS members with a care plan meeting the criteria outlined in the LTSS Comprehensive Care Plan and Update measure core rate.
Who is considered a primary care practitioner (PCP) for the purpose of calculating the LTSS Shared Care Plan with Primary Care Practitioner (PCP) measure?
A PCP is a physician, non-physician (for example, nurse practitioner, physician assistant), or group of providers who offers primary care medical services. However, a care plan can be shared with a medical care practitioner other than the PCP if the practitioner is identified by the member as the primary point of contact for their medical care. Therefore, any medical care practitioner identified by the member as the primary point of contact for their medical care is considered their PCP for the purpose of calculating the measure.
Why is the care plan shared just with the primary care practitioner (PCP) or other documented medical care practitioner identified by the Managed Long Term Services and Supports (MLTSS) member?
The care plan is shared with the PCP to promote coordination of medical and LTSS services.