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
- MLTSS Measures Technical Specifications and Resource Manual 2022 (PDF, 950.4 KB) contains 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:
- MLTSS-1: Long-Term Services and Supports Comprehensive Assessment and Update
- MLTSS-2: Long-Term Services and Supports Comprehensive Care Plan and Update
- MLTSS-3: Long-Term Services and Supports Shared Care Plan with Primary Care Provider
- MLTSS-4: Long-Term Services and Supports Reassessment/Care Plan Update after Inpatient Discharge
- MLTSS-5: Screening, Risk Assessment, and Plan of Care to Prevent Future Falls
- MLTSS-6: Long-Term Services and Supports Admission to a Facility from the Community
- MLTSS-7: Long-Term Services and Supports Minimizing Facility Length of Stay
- MLTSS-8: Long-Term Services and Supports Successful Transition after Long-Term Facility Stay
- The Medicaid MLTSS-4 Value Sets (XLSX, 2.24 MB) includes 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), SNOMED, and Uniform Billing (UB) codes, and HEDIS© value sets, used to calculate the Medicaid LTSS Reassessment/Care Plan Update After Inpatient Discharge measure.
- The Medicaid MLTSS-6, MLTSS-7, and MLTSS-8 Value Sets (XLSX, 29.23 KB) include the codes to calculate MLTSS-6: Medicaid LTSS Admission to a Facility from the Community, MLTSS-7, NQF 3457: Medicaid LTSS Minimizing Facility Length of Stay, and MLTSS-8: Medicaid LTSS Successful Transition After Long-Term Facility Stay
- LTSS Risk Adjustment Tables (XLSX, 59.69 KB) 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 (PDF, 2.41 MB)): 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 (PDF, 2.77 MB): 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.
- : A timeline for optimal planning and implementation of MLTSS 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 (PDF, 210.48 KB).
*For accessibility issues with accessing the MLTSS tool email Medicaid.email@example.com for assistance.