NSCLC: Details Matter: New Resource Will Help Advocates Get MLTSS Right

From our colleagues at NSCLC: 

A wave of new Medicaid Managed Long-Term Services (MLTSS) programs is sweeping the country and promises to impact the way care is delivered to millions of the nation’s seniors and people with disabilities.  Whether this impact is ultimately positive or negative will depend on the details of how these new systems are designed, implemented and held accountable. 

The details – while complex and often difficult to grasp – really matter.  That is why NSCLC developed the Advocates Library of Managed Long-Term Services and Supports Contract Provisions.

Why Contracts Matter

Can the beneficiary select members of their care team?  What role does the beneficiary play in creating and approving a care plan?  How does a beneficiary exercise the right to self-direct their care?  What providers are covered by care continuity provisions and for how long?  What notice is required when a service is denied?  What information must a plan provide to a beneficiary during an appeal process?  Which LTSS services must be provided?  

Many answers to these and other questions – the details – will be provided in contracts between states and the Managed Care Organizations (MCOs) selected to offer benefits in the MLTSS system.  Beneficiary protections and program rules that used to be detailed in statute, regulation and guidance will now be fleshed out most fully in these plan contracts.  This is a change that advocates must adjust to.   

What’s in the Library?

NSCLC’s online library summarizes existing MLTSS contract provisions by topic along with a page number citation for each cited provision. Topics covered include appeals and grievances, care continuity, care transitions and many more.  The library contains over 1,000 citations to current managed care contracts to allow advocates to easily find the original text.  The contracts themselves are also available here – in one place – so that advocates can read the exact contractual language and surrounding provisions.

As advocates work with their states to design new or improve existing MLTSS programs, the Library provides an extensive catalogue of model contract language to draw from.  For the first time, advocates will be able to easily research and compare contracts across states to help identify the best approach to the problem they are seeking to solve.  Looking for contract language that will ensure beneficiaries can participate in the care planning process?  You’ll find examples in the library.  Looking for language that will ensure access to needed providers during the transition to managed care?  You’ll find examples in the library.  Looking for language that allows beneficiaries to request the provision of alternative services to avoid institutionalization? You’ll find examples in the library. 

Don’t Miss the Related Webinar Series

NSCLC will be hosting a series of webinars to introduce advocates to the tool and to share findings of our research.  The first webinar will be held on March 7 at 2PM EST and will review various state practices for service planning and self-direction in MLTSS, with a focus on those practices that best preserve consumer control.  You can get more details and register here.

Please use the tool, share the tool and let us know what modifications and additions would be most helpful.  We look forward to working with advocates to get the details of MLTSS right.

NSCLC thanks The Retirement Research Foundation, the Atlantic Philanthropies and the Skadden Fellowship Foundation for supporting this webinar and the development of the Advocate’s Library.

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  • LAAAC is managed by St. Barnabas Senior Services; Funded, in part, by Archstone Foundation.
  • St. Barnabas Senior Services

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