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States should develop a comprehensive uniform assessment instrument to determine individual needs and develop a service plan. It should be used in all state LTSS programs. 

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. 

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.

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.