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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

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Both the State Medicaid Director Letter describing the Substance Use Disorder (SUD) section 1115 demonstration opportunity and the Centers for Medicare & Medicaid Services (CMS) SUD Implementation Plan template, reference needs assessment tools and program standards established by the American Society for Addiction Medicine (ASAM). Is a state required to reference or rely on the ASAM Criteria in implementing an SUD section 1115 demonstration?

No, a state is not required to reference or rely on the ASAM Criteria however, states should use guidelines/patient placement tools that are comparable to ASAM criteria. The State Medicaid Director Letter describing the SUD section 1115 demonstration opportunity references the ASAM Criteria as a recognized standard and an example of a patient placement assessment tool that states could use. Participating states are expected to ensure that providers use an SUD-specific, multi-dimensional assessment tool in determining the types of treatments and level of care a beneficiary with an SUD may need. The ASAM Criteria is referenced as a representative example of such an assessment tool. 

Some states proposed alternative needs assessment tools. CMS reviews each alternative proposal on an individual basis, and CMS has so far determined that those alternatives are comparable to the ASAM Criteria and meet the expectations for this demonstration initiative. In addition, participating states are expected to implement provider qualifications for residential treatment providers that reflect well-established standards for these treatment settings. Again, the ASAM Criteria is referenced as an example of a resource that states may use for determining those standards.

FAQ ID:93681

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

What if a Managed Long Term Services and Supports (MLTSS) member refuses an LTSS Comprehensive Assessment and Update measure assessment?

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 also be reported along with the measure performance rate.

FAQ ID:89101

What if a Managed Long Term Services and Supports (MLTSS) member could not be reached for an LTSS Comprehensive Assessment and Update measure assessment?

There must be documentation that at least three attempts were made to reach the member, and that the member could not be reached, which would result in exclusion from the measure. The rate of exclusion due to inability to reach a member should also be reported along with the measure performance rate.

FAQ ID:89106

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.

FAQ ID:89201

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.

FAQ ID:89206

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.

FAQ ID:89211

What are some acceptable ways to share the care plan with the primary care practitioner (PCP)? What if the Managed Long Term Services and Supports (MLTSS) participant refuses to share it?

The measure specifications allow sharing the care plan by mail, fax, secure email, or mutual access to an electronic portal or Electronic Health Record. Members who refuse to share their care plan are excluded from the measure denominator, but there must be documentation in the record that the member refused to share the care plan (noting verbal refusal suffices). The rate of exclusion due to a member refusing to share their care plan with the PCP should also be reported along with the measure performance rate.

FAQ ID:89216

Does the full Managed Long Term Services and Supports (MLTSS) care plan need to be shared with the primary care practitioner (PCP) to meet the numerator criteria for the LTSS Shared Care Plan with Primary Care Practitioner (PCP) measure?

No. MLTSS plans are not required to share the full care plan with the PCP or other documented medical care practitioner. MLTSS plans may choose which parts of the care plan are most relevant to the practitioner.

FAQ ID:89221

Is the provider's signature on the shared Managed Long Term Services and Supports (MLTSS) care plan required?

No, the LTSS Shared Care Plan with Primary Care Practitioner (PCP) measure only looks to see that a care plan was sent to a primary care practitioner (PCP) by the MLTSS plan. No signature from the PCP is necessary to count towards the numerator of this measure.

FAQ ID:89226

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