U.S. Flag

An official website of the United States government

Frequently Asked Questions

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.

FAQ Library

Showing 51 to 60 of 749 results

Where can I find the technical specifications and other materials related to Managed Long Term Services and Supports (MLTSS) measures?

The technical specifications and webinar materials for these measures are available on the MLTSS page:

FAQ ID:89021

Do Managed Long Term Services and Supports (MLTSS) measures apply to participants in Home and Community Based Services 1915(c) waiver programs?

The measures are intended for any MLTSS plan that covers Medicaid LTSS benefits. Federal regulations pertaining to 1915(c) waivers require person-centered service plans,1 but states can decide whether to require MLTSS plans participating in a state program operating under 1915(c) authority report these measures, and if they do, states can specify which types of plans and eligible members to which the measures apply.

1"In accordance with 42 CFR §441.301 (b)(1)(i), all waiver services must be furnished pursuant to a written service plan that is developed for each waiver participant." (1915c waiver application, Instructions, Technical Guide and Review Criteria (PDF, 2.29 MB) , Appendix D-1: Service Plan Development, CMCS, DEHPG, November 2014.

FAQ ID:89061

Do I need value sets to calculate any of the five the Managed Long Term Services and Supports (MLTSS) assessment and care planning measures? If so, where can I find the value sets?

Value sets are the complete set of procedure and diagnostic codes used to identify a service or condition included in a measure. One of the assessment and care planning measures—LTSS Reassessment/Care Plan Update after Inpatient Discharge—uses value sets to identify potentially planned hospitalizations. Please see "Do I need to use value sets to calculate these measures? If so, where can I find the value sets?" for more information regarding using value sets for the three institutional rebalancing and utilization measures.

View the value sets (XLSX, 2.88 MB) . Please see Table 2 in the "LTSS Value Sets to Codes" tab. Table 1 in the "LTSS Measures to Value Sets" tab shows each value set needed for each measure.

FAQ ID:89076

Does the LTSS Reassessment/Care Plan Update after Inpatient Discharge measure include discharges for planned hospital admissions?

No; discharges for planned hospital admissions are excluded from the measure denominator. Identify planned discharges using the value sets (XLSX, 2.88 MB) .

FAQ ID:89236

Must the completion of a Managed Long Term Services and Supports (MLTSS) comprehensive care plan take place in the home?

No, for the LTSS Comprehensive Care Plan and Update measure, the care plan does not have to take place in the member’s home. However, it must be done face-to-face unless certain exceptions are met. These exceptions include circumstances in which:

  • The member was offered a face-to-face discussion and refused (either refused a face-to-face encounter or requested a telephone discussion instead of a face-to-face discussion).
  • The state policy, regulation, or other state guidance excludes the member from a requirement for face-to-face discussion of a care plan.

FAQ ID:89146

If, after discharge from an inpatient facility, the member has not had a change in condition or needs, is a new comprehensive assessment and care plan required?

A reassessment with the member after they have been discharged from an inpatient facility is required to determine whether a member has had a change (or no change) in their LTSS needs. Even if the reassessment conducted post-discharge finds no change in a member’s LTSS needs, the second rate for this measure (Reassessment and Care Plan Update after Inpatient Discharge), Managed Long Term Services and Supports (MLTSS) plan care managers should conduct a care plan update and document that they considered each of the nine core elements of the care plan, and determined that the plan of care for each element remains the same; documentation of “no changes” in the care plan as a whole does not meet the numerator criteria.

FAQ ID:89256

Do the data elements comprising the plan of care to prevent future falls need to be documented as part of a comprehensive care plan?

No. Although a comprehensive care plan may include the elements comprising a plan of care to prevent future falls, the measure does not require the plan of care elements to be documented as part of a comprehensive care plan. For this measure, a plan of care is considered complete if the member record includes any documentation of exercise therapy or referral to exercise between August 1 of the year prior to the measurement year and December 31 of the measurement year.

FAQ ID:88991

Do the data elements comprising the falls risk assessment need to be documented as part of a comprehensive assessment?

No. Although a comprehensive assessment may include falls risk assessment elements, this measure does not require the risk assessment elements to be documented as part of a comprehensive assessment. For this measure, a falls risk assessment is considered complete if the member record includes any documentation of a balance/gait assessment, and documentation of assessment of postural blood pressure, vision, home fall hazards, and/or medications.

FAQ ID:88961

Are there exclusions for the Long Term Services and Supports Admission to an Institution from the Community measure's numerator?

When calculating the measure’s numerator (number of admissions to an institution), do not include admissions that are direct transfers from another institution, admissions from the hospital that originated from an institution, or admissions for individuals who do not meet the continuous enrollment criteria. If the member’s admission resulted in death in the institution or death within one day of discharge from the institution, do not include the admission in the numerator.

FAQ ID:91121

Must the Managed Long Term Services and Supports (MLTSS) LTSS Comprehensive Assessment and Update measure assessment take place in the home?

Yes, the assessment for the LTSS Comprehensive Assessment and Update measure is required to take place in the member’s home as a face-to-face discussion unless certain exceptions are met. These exceptions include circumstances in which:

  • The member was offered an in-home assessment and refused the in-home assessment (either refused to allow the care manager into the home or requested a telephone assessment instead of an in-home assessment).
  • The member is residing in an acute or post-acute care facility (hospital, skilled nursing facility, other post-acute care facility) during the assessment time period.
  • The state policy, regulation, or other state guidance excludes the member from a requirement for in-home assessment.

FAQ ID:89086

Show entries