Coordination of Long-Term Services and Supports

Background

MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. is the single largest public funding source for long-term services and supportsLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. ( LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. ). It is a combined federal-state program. Some MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. services are federally mandated, and others are optional at the states' discretion. Thus, state MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. programs can vary considerably, both with regard to the services covered and how the program is administered. Many states also have their own LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. programs for individuals who need services but do not meet MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. 's stringent eligibility criteria. States also operate programs with federal grant funding, for example, through the Older Americans Act. Consequently, in many states, LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. program administration is dispersed across several agencies and departments. As a result, consumers frequently have difficulty identifying the programs for which they are eligible and obtaining the services they need.

Many policymakers and state officials believe that strategies to improve coordination between and among LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. programs should begin with the consolidation of LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. program administration, policies, and budgets within one state agency. Using a global budget for all publicly funded LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. would also help give individuals a choice where to receive services. Another strategy to improve coordination is to establish single-entry points for all LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. . The term means that an individual seeking LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. can obtain comprehensive information and apply for services through multiple programs at the same time.

All states have a single-entry point for people seeking publicly or privately funded LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. , such as an Aging and Disability Resource CenterState-operated organizations that provide information about and access to all of the long-term services and supports available to older adults and people with disabilities. Also known as Single Point of Entry and No Wrong Door systems. ( ADRCState-operated organizations that provide information about and access to all of the long-term services and supports available to older adults and people with disabilities. Also known as Single Point of Entry and No Wrong Door systems. ) or a No Wrong Door system. Single-entry points enable individuals to obtain information about all LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. in a given geographic area, have their needs assessed, and their eligibility for public programs determined. Some states have set up their systems to authorize services as well. ADRCsState-operated organizations that provide information about and access to all of the long-term services and supports available to older adults and people with disabilities. Also known as Single Point of Entry and No Wrong Door systems. can also provide information about affordable housing options.

States often have a different assessment instrument for each LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. program to determine eligibility and develop a service plan. If so, individuals applying to several programs will have to be assessed multiple times. A comprehensive uniform assessment instrument would eliminate this costly and time-consuming process and streamline eligibility determinations for multiple programs. Some states have developed such instruments.

Conflict-free care management can also improve service coordination. In conflict-free care management, the person providing service assessment, making decisions about which services will be provided and by whom, and providing service coordination is not affiliated with a service provider. The goal of conflict-free care management is to promote individual choice and independence. 
Many publicly funded state programs use care managers or care coordinators to assess a person's need for LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. and organize service delivery. Evidence shows that people with multiple chronic conditions and those who have both LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. and health care needs benefit from the services of care coordinators/care managers. These professionals can help them coordinate their care across multiple settings and providers.

COORDINATION OF LONG-TERM SERVICES AND SUPPORTS: Policy

COORDINATION OF LONG-TERM SERVICES AND SUPPORTS: Policy

Coordination among long-term services and supports (LTSS) providers

All federal and state agencies with a key role in financing or delivering LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. should coordinate their efforts. When appropriate and feasible, they should help coordinate activities among LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. agencies and agencies that serve people who use LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. . For example, those dealing with income support and housing.

Consolidated or coordination of LTSS agencies

States should consolidate or coordinate agencies responsible for LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. , including MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. , state-funded programs, Older Americans Act programs, and the state agency on aging. The single agency or effectively coordinated agencies should have responsibility for policy, funding, administration, and oversight of LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. programs that serve both older and younger people with disabilities. These responsibilities should include the determination of eligibility for public programs.

This includes MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. -funded institutional care and community-based programs such as personal care, home and community-based services waiver programs, managed LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. programs (including Programs of All-Inclusive Care for the Elderly), and state-funded LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. programs. The consolidated agency also should have responsibility for determining people's financial eligibility for MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. and LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. quality management. It should cover all populations of older adults and people with disabilities: older people, other adults with physical disabilities, and people with developmental disabilities.

Single-entry point for LTSS

The operations and functions of each organization in an Aging and Disability Resource CenterState-operated organizations that provide information about and access to all of the long-term services and supports available to older adults and people with disabilities. Also known as Single Point of Entry and No Wrong Door systems. ( ADRCState-operated organizations that provide information about and access to all of the long-term services and supports available to older adults and people with disabilities. Also known as Single Point of Entry and No Wrong Door systems. ) model vary greatly. States should streamline eligibility determinations for LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. programs, move toward person- and family-centered care, and increase public outreach so consumers know about these important information resources.

The entry point(s) should provide comprehensive, conflict-free, consumer-friendly counseling at critical decision points, including at home and in hospitals and at conveniently located offices in neutral settings, an 800 number to assist in finding the nearest office, and comprehensive information on service options and funding sources.

States should conduct assessments of, and devise service plans based on, consumers' needs and preferences, and promptly determine functional and financial eligibility for all publicly funded services.

The assessment of LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. needs and the delivery of services and support should be conflict-free.

Global budgets should be based on the projected needs of the population and anticipated changes in LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. delivery and must be adjusted for expected inflation.

Centralized administration

A centralized state LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. agency or coordinated agencies should:

  • eliminate unnecessary paperwork and other inefficiencies through administrative and systems reform to help contain costs;
  • streamline the process for people covered by more than one program; and
  • have a global budget with authority to allocate funding among an array of LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. , including both institutional and home and community-based services.

The agency or agencies should also:

  • have fair rate-setting and contracting processes for service providers;
  • have a structure and process for ensuring quality oversight and outcomes throughout the system;
  • direct providers to use standard, simple terms and billing forms, including electronic billing; and
  • make current data on nursing facility charges and all other LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. providers available to the public.

 

Conflict-free care management

Conflict-free care management should be an essential part of any LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. system. It can address the fragmentation of present delivery systems and help ensure that individual needs are met cost-effectively. States should ensure that conflict-free care management is available through a community organization (such as an ADRCState-operated organizations that provide information about and access to all of the long-term services and supports available to older adults and people with disabilities. Also known as Single Point of Entry and No Wrong Door systems. ) that does not directly provide LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. . This would not apply to people in managed care programs. At the request of an individual or family member, conflict-free assessment, counseling, and assistance should be provided prior to entering any type of LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. facility. It should be available at any time, regardless of location or level of care.

Training care managers:

States should require competency-based training, annual continuing education, and supervision for care managers. This can ensure high-quality service plans that meet consumers' needs and programs' cost constraints.

States should require care managers to practice according to professional standards and norms, which include attention to recommended safe and manageable caseload limits.

States should ensure that public and private geriatric care managers can demonstrate competency as required by the state.

States should require care-management agencies to be conflict-free and have strong consumer representation on their boards, particularly LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. consumers.

Consumer focus

States should ensure that all LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. programs use a person- and family-centered (when desired) service planning process that reflects individuals' preferences and goals. This planning should empower older adults and people with disabilities by recognizing that the person receiving services is the expert on their own care. Individuals should be active in their own service planning. They may include other people of their choice, such as family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. .

Consumers should be guaranteed a choice of care managers and the ability to change care managers.

Care managers should inform consumers about the costs of service options. Consumers should sign off on their service plan as equal partners.