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
The 2016 Medicaid and CHIP Managed Care Final Rule (CMS 2390-F) requires MLTSS programs to provide person-centered processes to ensure that beneficiaries’ medical and non-medical needs are met and that they have the quality of life and level of independence they desire [1]. These programs must produce a treatment or service plan that is developed with the member, and is reviewed at least every 12 months.
CMS’s Home & Community-Based Services 1915(c) guidelines establishes waivers for person-centered service planning, which covers LTSS programs in some states [2].
Historical Results – National Averages
Performance results for this measure are currently unavailable.
References
- Centers for Medicare & Medicaid Services. May 6, 2016. “Medicaid and Children’s Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered.” Federal Register 81, no. 88: 27497–901. https://www.federalregister.gov/d/2016-09581
- Centers for Medicare & Medicaid Services. “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
