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Many chronic illnesses and other health conditions—such as heart disease, cancer, multiple sclerosis, arthritis, diabetes, and emphysema—can result in functional limitations.
Federal and state governments should develop comprehensive, coordinated approaches to financing and delivering care to individuals whose needs are currently met through multiple service systems.&nb
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.