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 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
Should the rate of required exclusions be reported with the Screening, Risk Assessment, and Plan of Care to Prevent Future Falls measure's Part 1 performance rate?
The measure excludes plan members who are not ambulatory from the measure rate, but it is not necessary to report the number of members excluded with the measure’s performance rate.
Is a specific screening tool required for the Screening, Risk Assessment, and Plan of Care to Prevent Future Falls measure?
No, a specific screening tool is not required for this measure. However, potential screening tools may include the Morse Fall Scale and timed Get-Up-And-Go test.
What is the difference between a screening (Part 1) and a risk assessment (Part 2) for the purposes of calculating the Screening, Risk Assessment, and Plan of Care to Prevent Future Falls measure?
A falls screening is an evaluation of whether a Managed Long Term Services and Supports plan member has experienced a history of falls and/or problems with balance or gait. A falls risk assessment includes a balance/gait assessment and one other assessment component and should only be performed for members with a documented history of falls (at least two falls or one fall with injury in the past year).
Where can I find the technical specifications and other materials related to Managed Long Term Services and Supports (MLTSS) measures?
Who should I contact if I have additional questions about the Managed Long Term Services and Supports (MLTSS) measures?
If you have additional questions about these measures, please submit your question to the technical assistance mailbox at MLTSSmeasures@cms.hhs.gov for assistance.
Why were the Managed Long Term Services and Supports (MLTSS) measures developed?
As more states shift to MLTSS and gain more experience, the need to measure program outcomes and quality has increased. The new quality measures, which were carefully designed for beneficiaries enrolled in MLTSS plans, represent a major step forward in giving the Centers for Medicare & Medicaid Services (CMS), states, MLTSS plans, providers, and consumers the ability to compare the performance of MLTSS programs and plans within and across states. Specifically, CMS wanted to create nationally-standardized measures meeting importance, usability, feasibility, and scientific validity and reliability standards for use across MLTSS plans and state Medicaid programs to fill key gaps in MLTSS measure domains while not duplicating other measures that have been developed or are currently under development.
Is the Centers for Medicare & Medicaid Services (CMS) requiring reporting of the Managed Long Term Services and Supports (MLTSS) measures?
No, CMS does not require states or MLTSS plans to report these measures. However, states may choose to require plans to report any of these measures to the state Medicaid agency.
A Managed Long Term Services and Supports (MLTSS) plan may document the data elements required for MLTSS measures, but the information may be recorded in different locations or abstracted inconsistently from members' records. What can states and plans do to ease the potential burden of data collection and help standardize the data collection process?
Through our discussions with MLTSS plans, we learned that plans—particularly those operating in multiple states—can ease the burden of data collection by mapping their existing assessment and care plan tools to the standardized data elements and terminology in these measures, which would make it easier to abstract data and standardize the data collection process. It is also important for MLTSS plan managers to train staff to document assessment and care plan elements consistently, as well as train individuals responsible for collecting data on how to interpret each of the elements specified in each measure. Plans can also ease the burden of data collection by ensuring data from multiple sources are consolidated into a central data system.
Care managers often do not document data elements in the assessment and care plan measures unless the member has "a problem." For example, they may not document that they assessed the member's vision or need for an assistive device if no problem was identified. How can states or plans address this issue?
Managed Long Term Services and Supports (MLTSS) plan managers should provide training on proper documentation practices to care managers and other delegated staff. States and MLTSS plans could consider including data field entry options to remind care managers to record all results of the assessment, even if findings are negative, that is, the member does not have a problem or need assistance or services. For example, states and plans could include a question in the member’s record that requires the care manager to document both whether an assessment was performed and whether a problem was identified, along with another required field to include the details of the problem if there was a problem identified.
How should states validate plan-reported Managed Long Term Services and Supports (MLTSS) measure rates?
If MLTSS plans report measure rates directly to the state, the state should conduct an independent review of a sample of members included in the reported measures, for example, by the External Quality Review Organization or state-employed abstractors.