The percentage of long-term services and supports (LTSS) organization members 18 years of age and older who have documentation of a comprehensive LTSS care plan in a specified time frame that includes core elements. The following rates are reported:
- Care Plan With Core Elements Documented. Members who had a comprehensive LTSS care plan with 9 core elements documented within 120 days of enrollment (for new members) or during the measurement period (for established members).
- Care Plan With Supplemental Elements Documented. Members who had a comprehensive LTSS care plan with 9 core elements and at least 4 supplemental elements documented within 120 days of enrollment (for new members) or during the measurement period (for established members).
Why It Matters
A comprehensive care plan translates what an assessment uncovers into the services, supports and goals that will actually be delivered. For people who use long-term services and supports (LTSS), the care plan identifies needs and risks, names who is responsible for addressing them and records what the member says matters most to them.
The 2016 Medicaid and CHIP Managed Care Final Rule requires managed LTSS (MLTSS) programs to use person-centered processes so that members’ medical and non-medical needs are met and members have the quality of life and level of independence they desire. It also requires MLTSS programs to develop a treatment or service plan with the member and review this plan at least every 12 months [1]. Person-centered service planning requirements also apply to home and community-based services (HCBS) furnished under 1915(c) waiver and 1915(i) state plan authority, which cover LTSS programs in some states [2,3]. The 2024 Ensuring Access to Medicaid Services final rule further requires states to review the person-centered service plan for waiver-enrolled individuals at least annually and revise it as needed [4].
Despite these requirements, there is no national standard for what a care plan must contain. Requirements govern the planning process more than the content, making it difficult to compare care plan completeness across states and plans. LTSS-CPU provides a common standard by measuring whether the care plan documents a defined set of core and supplemental elements within a specified time frame.
Well-developed care plans are associated with better communication among members, caregivers and providers; clearer accountability across the care team; and stronger self-management. Because Medicaid finances about half of national long-term care spending [6], improving the completeness of care plans for this population has both clinical and financial importance.
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.
- Centers for Medicare & Medicaid Services. n.d. “Home & Community-Based Services 1915(c).” Medicaid.gov. https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c.
- Centers for Medicare & Medicaid Services. n.d. “Home & Community-Based Services 1915(i).” Medicaid.gov. https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915i.
- 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.
