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All federal and state agencies with a key role in financing or delivering LTSS should coordinate their efforts.

People should be eligible for LTSS on the basis of functional needs. 

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.

Congress should make pre-dispute mandatory arbitration provisions in LTSS contracts unenforceable.