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LTSS Performance Measurement and Network Adequacy Standards

Health plans that contract with states to take the responsibility for and manage longterm services and supports (LTSS) can provide value for persons that use LTSS and their families, as well as for state governments seeking solutions for expanding access, managing LTSS spending, and complying with federal regulatory requirements.

As managed LTSS (MLTSS) plans, we assume a special obligation to ensure people with significant disabilities of all ages receive the supports and services they need to live independently and with dignity of risk in the setting of their choice. Earning the trust of consumers, their families and advocates, and of the elected officials who represent them, is an essential element of success in managing LTSS. To earn this trust and continue to deliver on the promise of integrated care with better outcomes requires comprehensive quality measurement that empowers consumers to make informed choices, ties payment to MLTSS program goals and member outcomes, and drives system change.

While MLTSS plans are required to collect, analyze and report on volumes of data about our members and the services they receive, there are, to date, no generally agreed-upon, national, validated measures to hold us accountable for the quality of those services or to reliably compare our performance state-by-state and nationally. In a recent report to Congress, the Government Accountability Office (GAO) found that most of the states analyzed in the report did not link payments to plan performance on meeting national MLTSS program goals because “standardized measures for long-term services and supports are not available.”1 GAO suggested that “provisions in CMS’s new managed care rule could provide an opportunity for more regular and standardized MLTSS data from states.”

Read more here.


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