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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. 

The federal government and the states should not accept accreditation by private bodies in lieu of federal or state licensing, certification, or enforcement of standards.

States considering payments to LTSS providers based on improved quality outcomes should rely on data from pilot projects developed with strong consumer participation.