Long-Term Care Services and Supports (LTSS) are designed to support the needs of children, adults, and seniors with varying degrees of physical, cognitive, emotional, and medical health abilities. Many of these individuals are Medicaid beneficiaries enrolled in managed care programs. This can be very challenging for providers as they try to keep up with changing Medicaid LTSS regulations. In an effort to meet this challenge, The Center for Medicare and Medicaid Services (CMS) has designated the necessary elements of a high-performing, person-centered Medicaid LTSS program. These elements include: creating a scalable technology strategy, focusing on a person-centered process, and defining a participant protection strategy.
Creating a Scalable Technology Strategy
Medicaid LTSS programs are required to monitor all aspects of plan performance, including the delivery of LTSS, and to use the data collected to improve plan performance. In addition, readiness reviews of the plan’s ability and capacity are required in the following areas: service delivery, care management, and service planning. That is a lot to juggle. And what do you do when you finally have all the moving pieces working together and Medicaid changes the requirements? Or you expand your services into new areas that have different compliance requirements? This is when it is critical to have a system that can scale as your organization grows, ensure coordination between multiple agencies including state and federal providers, and update information as new requirements are released.
The goal of these CMS requirements is to shift LTSS away from exclusively focusing on treating the sick to proactively working to keep a community healthy. CMS requires Medicaid LTSS entities to coordinate care between medical, community, and social support providers in order to ensure person-centered care. In order to accomplish this, Medicaid LTSS entities are required to comprehensively assess patient needs, identify any ongoing special conditions that require a course of treatment, and then accurately report this information to state and federal regulatory organizations. In addition, as long-term care patients transition between various levels and locations of care it is imperative that vital information, such as the patient’s medical health record, treatment plan, and case notes, travel with them. This is where integrated case management software plays an important role. By providing multiple providers access to a patient’s information, a holistic care experience is ensured.
Participant Protection Strategy
With this increased sharing of LTSS patient info in order to coordinate care, it is critical to protect patient privacy. For this reason, CMS has outlined a number of LTSS quality requirements in order to maintain HIPAA and other regulatory compliance:
- Each LTSS entity is required to implement an ongoing comprehensive quality assessment and performance improvement program that includes measures relating to quality of life, rebalancing, and community integration activities
- Performance improvement programs must have mechanisms to assess the quality and appropriateness of care furnished to individuals, including during care transitions and as measured against those services in their care plans
- The state must review the results of any plan efforts to support community integration for enrollees using LTSS at least annually
- States must create a written managed care quality strategy for assessing and improving the quality of healthcare and services furnished, which must contain MLTSS-specific quality considerations
Client Track case management software helps organizations maintain compliance with CMS and state agencies. We specialize in:
- Individual goals, outcomes, and progress reporting
- Medication tracking module
- Reporting and analytics
- HIPAA Compliance – Built-in security controls keep patient data private with multiple levels of access control even among providers and care teams within the same care organization
We’re here to help meet the demands of managing your technical requirements to ensure the best possible outcome for your clients.
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