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Many states are enrolling Medicaid participants in capitated, risk-based managed care plans designed to coordinate all their care, including long-term services and supports (LTSS) if needed.
No person should be enrolled in a Medicaid-managed long-term services and supports (LTSS) plan without first receiving an assessment of their needs and preferences.
Government and providers of long-term services and supports (LTSS) use various approaches to promote service quality and protect consumer rights.
States should enact licensing or comparable certification requirements for all long-term services and supports (LTSS) providers.
Enforcement should include swift and meaningful penalties for substandard care.
States should fund sufficient quality monitors to inspect all providers at least annually. Complaints should be responded to promptly. Inspections should be unscheduled.
States should provide effective complaint systems with prompt resolution.
The federal government should increase funding and strengthen requirements for states to implement Long-Term Care Ombudsman programs.
State governments should fully fund agencies responsible for investigating abuse and neglect and ensure that they have the capacity to respond appropriately in a timely manner.
Congress should make pre-dispute mandatory arbitration provisions in LTSS contracts unenforceable.