Frequently Asked Questions

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.

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.

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).

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

• Technical specifications
• Value sets
• Risk adjustment tables
• Webinar slides
• Webinar recording

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

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.

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.

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.

No. However, when identifying the measure’s denominator from the eligible population, there are a few cases in which you should not include member months. For example, do not include months when the plan member was residing in an institutional facility for the entire month (that is, there were no days in the month spent residing in the community). If a member died, do not include the month during which the member died and any subsequent months of enrollment in the measure’s denominator.

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.