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.
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 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
- The LTSS Quality Measures Technical Specifications and Resource Manual 2024 includes 15 nationally standardized CMS measures for managed care and fee-for service (FFS) delivery systems. The eight MLTSS quality measures and seven Medicaid FFS LTSS quality measures for states and Medicaid managed care programs are aligned pairs, collectively referred to as LTSS quality measures, with unique technical specifications. As of 2024, states with hybrid LTSS programs, delivered via FFS and managed care delivery systems, should refer to both the FFS LTSS and MLTSS measures’ specifications to evaluate performance for their state’s LTSS programs. If you have technical questions about these measures, please contact MLTSSmeasures@cms.hhs.gov for assistance. The LTSS quality measures are
Assessment and Person-Centered Planning Quality Measures
- Comprehensive Assessment and Update (MLTSS-1 and FFS LTSS-1; CMIT Measure ID #960)
- Comprehensive Person-Centered Plan and Update (MLTSS-2 and FFS LTSS-2; CMIT Measure ID #961)
- Shared Person-Centered Plan with Primary Care Provider (MLTSS-3 and FFS LTSS-3; CMIT Measure ID #963)
- Reassessment and Person-Centered Plan after Inpatient Discharge (MLTSS-4 and FFS LTSS-4; CMIT Measure ID #962)
Falls Risk Screening Quality Measure
LTSS Rebalancing and Utilization Quality Measures
- Admission to a Facility from the Community (MLTSS-6 and FFS LTSS-6; CMIT Measure ID #20)
- Minimizing Facility Length of Stay (MLTSS-7 and FFS LTSS-7; CMIT Measure ID #968)
- Successful Transition after Long-Term Facility Stay (MLTSS-8 and FFS LTSS-8; CMIT Measure ID #414)
The Value Sets for MLTSS and FFS LTSS Measures include the lists of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), Systematized Nomenclature of Medicine (SNOMED®), and Uniform Billing (UB) codes, used to calculate both versions of the LTSS-4, LTSS-6, LTSS-7, and LTSS-8 measures.
The LTSS Risk Adjustment Tables Workbook includes the coefficients (model weights) for each risk factor and the mapping of the diagnosis codes to the risk factors.
- FAQs: Medicaid Managed Long Term Services and Supports Measures
- 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.
- The Growth of MLTSS Program: A timeline for optimal planning and implementation of MLTSS programs.
- Transitioning LTSS Providers Into Manag: 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.gov@cms.hhs.gov for assistance.