The percentage of long-term services and supports (LTSS) organization members 18 years of age and older who have documentation of a comprehensive LTSS assessment in a specified time frame that includes documentation of core elements. The following rates are reported:
- Assessment of Core Elements. Members who had a comprehensive LTSS assessment with 9 core elements documented within 90 days of enrollment (for new members) or during the measurement period (for established members).
- Assessment of Supplemental Elements. Members who had a comprehensive LTSS assessment with 9 core elements and at least 12 supplemental elements documented within 90 days of enrollment (for new members) or during the measurement period (for established members).
Why It Matters
People enrolled in Medicaid long-term services and supports (LTSS) may have complex, intersecting needs – physical, cognitive and behavioral health conditions, functional limitations and social support needs – that require coordination across multiple providers and settings. A comprehensive assessment is the foundation of person-centered care planning: without a complete and current picture of a member’s needs, risks and preferences, care plans are unlikely to address what matters most to the member.
The 2016 Medicaid and CHIP Managed Care Final Rule requires state Medicaid organizations operating LTSS to implement mechanisms for identifying, assessing and producing a treatment or service plan for individuals with special health care needs. It also requires state Medicaid organizations to make a best effort to screen each new enrollee’s needs within 90 days of the effective date of enrollment, including subsequent attempts if the initial attempt is unsuccessful [1]. The 2024 Ensuring Access to Medicaid Services final rule strengthens oversight of person-centered service planning in home and community-based services and requires states to reassess an enrollee’s functional need at least every 12 months, and whenever the enrollee requests a reassessment or their circumstances change [2].
Assessment practice varies widely. States generally use separate assessment tools for different populations, and a MACPAC review identified at least 124 functional assessment tools in use across state Medicaid organizations [3], making it difficult to compare the completeness of assessments across plans and states. LTSS-CAU addresses this gap by measuring whether a comprehensive assessment was completed in a specified time frame and whether specific core and supplemental elements were documented. Medicaid is the primary payer for LTSS in the United States and accounts for about half of national long-term care spending [4], so improving assessment completeness for this high-need, high-cost population is a direct lever for reducing avoidable risk.
Historical Results – National Averages
Performance results for this measure are currently unavailable.
References
- Centers for Medicare & Medicaid Services. 2016. “Medicaid and Children’s Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, and Revisions Related to Third Party Liability.” Federal Register 81, no. 88: 27497–901. https://www.federalregister.gov/d/2016-09581.
- Centers for Medicare & Medicaid Services. 2024. “Medicaid Program; Ensuring Access to Medicaid Services.” Federal Register 89, no. 92: 40542–874. https://www.federalregister.gov/d/2024-08363.
- Medicaid and CHIP Payment and Access Commission. 2016. “Functional Assessments for Long-Term Services and Supports.” In Report to Congress on Medicaid and CHIP, chap. 4. https://www.macpac.gov/wp-content/uploads/2016/06/Functional-Assessments-for-Long-Term-Services-and-Supports.pdf.
- Hinton, E., E. Williams, J. Raphael, A. Mudumala, R. Rudowitz, K. Gifford, A. Lashbrook, C. Knapp, B. Kidder, and B. Snyder. 2023. “Amid Unwinding of Pandemic-Era Policies, Medicaid Programs Continue to Focus on Delivery Systems, Benefits, and Reimbursement Rates: Results from an Annual Medicaid Budget Survey for State Fiscal Years 2023 and 2024.” KFF. https://files.kff.org/attachment/EXECUTIVE-SUMMARY-50-State-Medicaid-Budget-Survey-for%20State-Fiscal-Years-2023-and-2024.pdf.
