Managed Long Term Services and Supports
Managed Long Term Services and Supports (MLTSS) refers to the delivery of long term services and supports through capitated Medicaid managed care programs. Increasing numbers of states are using MLTSS as a strategy for expanding home- and community-based services, promoting community inclusion, ensuring quality, and increasing efficiency. The number of states with MLTSS programs increased from eight in 2004 to 16 in 2012, and the Centers for Medicare & Medicaid Services (CMS) has experienced increasing interest from states in the form of concept papers, waiver applications and requests for technical assistance.
MLTSS offers states a broad and flexible set of program design options, and may be used as an overarching structure to promote initiatives such as Money Follows the Person, participant-directed services, and the Balancing Incentive Program. States and stakeholders have expressed an interest in learning more about MLTSS and how new Long-Term Services and Supports (LTSS) opportunities in the Affordable Care Act may be incorporated into an MLTSS program.
Medicaid MLTSS programs can be operated under multiple federal Medicaid managed care authorities at the discretion of the state and as approved by CMS, including 1915a, 1915b, and 1115. There are requirements and limitations related to each authority, and managed care authority can be combined with other home and community based authorities in order to operate the MLTSS program (as with a concurrent 1915(b)/1915(c) for example).
In September 2014, CMS initiated a national, cross-state evaluation of MLTSS. The MLTSS evaluation is one component of a larger evaluation designed to track and evaluate several different types of Medicaid section 1115 demonstration waivers. However, the MLTSS component of the evaluation is not limited to programs using section 1115 demonstration authority. Learn more about the national, cross-state evaluation.
CMS developed a number of technical assistance tools for states, and other stakeholders to enhance the availability and quality of MLTSS. These tools include:
- Documents outlining CMS' expectations for MLTSS programs operating under section 1115 or 1915(b) authorities.
- Application of Existing External Quality Review Protocols to Managed Long Term Services and Supports: A guide to interpreting and applying existing External Quality Review protocols when assessing MLTSS program compliance
- Technical Specifications of eight quality measures for states to consider when using a managed care delivery system for providing long-term services and supports. If you have technical questions about these measures, please contact MLTSSmeasures@cms.hhs.gov for assistance. The measures are:
- LTSS Comprehensive Assessment and Update
- LTSS Comprehensive Care Plan and Update
- LTSS Shared Care Plan with Primary Care Practitioner
- LTSS Re-Assessment/Care Plan Update After Inpatient Discharge
- Screening, Risk Assessment, and Plan of Care to Prevent Future Falls
- LTSS Admission to an Institution from the Community
- LTSS Minimizing Institutional Length of Stay
- LTSS Successful Transition After Long-Term Institutional Stay
- Technical Specifications Supporting Documents
- LTSS Value Sets: Includes the list of International Statistical Classification of Diseases and Related Health Problems (ICD), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and Uniform Billing (UB) codes used to calculate four of the measures
- LTSS Risk Adjustment Tables: Includes the coefficients (model weights) for each risk factor and the mapping of the diagnosis codes to the risk factors
- The Growth of Managed LTSS Programs: 2017 Update: This study reviewed available information about the status of Medicaid MLTSS programs, as an update to the 2012 inventory below. Updates are provided on the prevalence of MLTSS programs, total enrollment, and specific program design elements as of August 2017.
- The Growth of MLTSS Programs: A 2012 Update: A white paper which provides an inventory of all current MLTSS programs and a projection of future programs as of July, 2012. The report includes state-by-state results and synthesizes findings across states, reporting national enrollment, characteristics of contractors, and multiple program features.
- Population Groups Enrolled in MLTSS: A chart building off the July, 2012 white paper, which lists the population groups that are enrolled in current MLTSS programs, as well as those projected to be enrolled in future MLTSS programs
- Timeline for Developing a MLTSS Program: A timeline for optimal planning and implementation of MLTSS programs.
- Transitioning LTSS Providers Into Managed Care Programs: A paper identifying the concerns and considerations in incorporating traditional LTSS providers into a managed care program
Additional resources for MLTSS programs are available in an Informational Bulletin released on May 21, 2013.
*For accessibility issues with accessing the MLTSS tool email Medicaid.firstname.lastname@example.org for assistance.