MES Certification Navigator
LTSS

Long Term Services & Supports

Medicaid is the primary payer across the nation for long-term care services. Medicaid allows for the coverage of these services through several vehicles and over a continuum of settings, ranging from institutional care to community-based long-term services and supports (LTSS). LTSS systems support the management of these services.

CMS-Required Outcomes (11)

RefOutcomeSources
LTSS1LTSS system generates notifications including eligibility determination; termination of state waiver (30 days in advance); and inspections taking place in a beneficiary's home when a beneficiary receives services in his/her own home or the home of a relative (HCBS waiver for individuals 65 and older) (48 hours in advance).
42 CFR 441.30742 CFR 441.35642 CFR 441.36542 CFR 431.20642 CFR 431.210
LTSS2LTSS systems stores proof of beneficiary consent to enroll in HCBS state plan or waiver-based programs.
42 CFR 441.301
LTSS3LTSS system assigns, tracks and changes beneficiary prioritization and waiver waitlist status.
42 CFR 441.305
LTSS4LTSS system maintains a record of beneficiaries who have left the waiver program due to death or loss of eligibility for Medicaid under the State Plan to replace those beneficiaries with others on the waitlist.
42 CFR 441.305
LTSS5LTSS system stores the person-centered plan, including any updates or changes containing all required information and consent signatures.
42 CFR 441.302
LTSS6LTSS system supports conflict-free case management via role-based access, proper firewalls, and mitigation strategies that provide beneficiaries appropriate access to records.
42 CFR 441.301HIPAA
LTSS7LTSS System supports completion of CMS Form 372.
42 CFR 433.11242 CFR 441.302
LTSS8LTSS system collects and saves prior authorizations to exchange with MMIS as needed to prevent the provision of unnecessary or inappropriate services and supports.
42 CFR 441.301
LTSS9LTSS system documents and tracks reportable events related but not limited to instances of abuse, neglect, exploitation, and unexplained death from case initiation to case closeout.
42 CFR 441.40442 CFR 441.585CMS Bulletin, Modifications to Quality Measures and Reporting in §1915(c) Home and Community-Based Waivers, March 12, 2014
LTSS10LTSS system collects grievances related but not limited to instances of abuse, neglect, exploitation, and unexplained death from case initiation to case closeout.
42 CFR 441.464
LTSS11LTSS system creates trend reports of critical incident causes and tracks trends of critical incidents after operational implementation of interventions/mitigations/corrective actions.
Application for a §1915(c) Home and Community-Based Waiver [Version 3.6, January 2019]Instructions, Technical Guide and Review Criteria p.242-243 (Appendix G-1-e)Modifications to Quality Measures and Reporting in §1915(c) Home and Community-Based Waivers, Page 10