Frequently Asked Questions

The Medicare Savings Program (MSP) Model application can be found here: Medicare Savings Programs (MSP) Model Application for Medicare Premium Assistance

FAQ ID:95161

The following measures assess institutional rebalancing and utilization:

• LTSS Admission to an Institution from the Community
• LTSS Minimizing Institutional Length of Stay
• LTSS Successful Transition after Long-Term Institutional Stay

FAQ ID:91101

Yes. Value sets are the complete set of procedure and codes used to identify a service or condition included in a measure. 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—use the "Institutional Facility"value set (XLSX, 2.88 MB). 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:91106

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.

FAQ ID:91111

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

• Technical specifications (PDF, 532.99 KB)
• Value sets (XLSX, 2.88 MB)
• Risk adjustment tables (XLSX, 59.69 KB)
• Webinar slides (PDF, 1014.2 KB)
• Webinar recording

FAQ ID:89021

If you have additional questions about these measures, please submit your question to the technical assistance mailbox at MLTSSmeasures@cms.hhs.gov for assistance.

FAQ ID:89026

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.

FAQ ID:89031

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.

FAQ ID:89036

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.

FAQ ID:89041

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.

FAQ ID:89051