What is LTSS?
Long-term services and supports (LTSS) offer health and social supports to older adults and people with disabilities to help them live more independently. LTSS activities include assistance with activities of daily living; help with cooking, cleaning, and other chores; adult day services; respite for caregivers; and residential services.
LTSS is delivered in both institutional settings, such as nursing facilities, and home and community-based settings. Home and community-based services (HCBS) allow older adults and people with disabilities to live in their home or a community-based setting of their choice.
Medicaid is the main payer of LTSS nationwide. Eligibility for Medicaid LTSS is complex and varies across state programs; recipients must meet both functional need criteria and financial criteria.
ADvancing States LTSS Policy Committee
ADvancing States hosts a monthly committee of state leaders focused on LTSS policy topics. See ADvancing States' Public Policy Committees for more information.
Key LTSS Policy Topics and Initiatives
The HCBS Access Rule
On May 10, 2024, CMS published the Ensuring Access to Medicaid Services final rule. This regulation adds new requirements for states in both managed care and fee-for-service (FFS) delivery systems regarding access to Medicaid HCBS. The regulation is referred to as the Access Rule.
The Access Rule imposes new requirements on virtually all aspects of states’ HCBS programs: payment, critical incident systems, timely access to services, and quality assurance and reporting. This is the most substantive rule impacting Medicaid HCBS programs since the HCBS Settings Rule was finalized in 2014.
Technical Assistance for Access Rule Implementation
ADvancing States and NASDDDS are joining forces to provide technical assistance to states on the implementation of the Access Rule, beyond what is traditionally available through the associations’ membership benefits. States may obtain technical assistance in a variety of areas pertaining to any of the Access Rule core components.
For additional information or to request technical assistance on the Access Rule, email Rachel Neely (rneely@advancingstates.org). See information about other types of enhanced technical assistance here.
MFP Requirements Related to HCBS Quality Measure Set
Money Follows the Person
Money Follows the Person (MFP) is a federal rebalancing demonstration program meant to give people who need LTSS an increased opportunity to live and receive care in community settings rather than institutional settings. MFP provides flexible grant funding opportunities for states to develop and test processes that advance LTSS system reform by increasing access to HCBS and creating a more person-centered system that prioritizes individual choice.
The MFP Demonstration has provided nearly $6 billion to 43 states and the District of Columbia since it was first authorized in 2005. The Consolidated Appropriations Act (CAA) of 2023 extended funding for MFP through September 2027.
ADvancing States continues to work with our partners to advocate for MFP funding extensions and reauthorization.
Quality Measure Set
As of 2024, states and territories receiving MFP funding will be required to begin reporting on a subset of the HCBS Quality Measures Set (HCBS QMS), which was released in July 2022 (State Medicaid Director Letter 22-003). Importantly, these states must report on all their section 1915(c), (i), (j), and (k) programs and section 1115 demonstrations that include HCBS for major population groups, not just those programs that would enroll MFP participants. Reporting will be required no sooner than September 2026 for measures collected in 2025.
The subset of measures to be reported is still in development. The QMS contains several measures from the National Core Indicators (NCI), such as measures related to health, choice, access, and person-centered planning. ADvancing States is collaborating with QMS partners to ensure that the final QMS best captures the needs and experiences of individuals receiving LTSS.
Enhanced technical assistance is available for states that would like additional guidance on preparing for the new MFP reporting requirements under the Access Rule.
If you have questions about MFP reporting and the HCBS QMS, please contact Rosa Plasencia rplasencia@advancingstates.org).
MLTSS
Over the past fifteen years, there has been significant growth in the number of states that utilize managed care organizations to deliver some or all of their LTSS. This model is known as managed long-term services and supports, or MLTSS. Managed care is one tool that a number of states are using as they seek to better integrate LTSS into the continuum of supports available to individuals, to improve care coordination and quality of services, to increase predictability in budgeting, and to control costs.
See additional information here.