FAQs on Managed Long-Term Services and Supports
What is Managed Long-term Services and Supports (MTSS)?
Managed care is an integrated delivery system of Medicaid long-term services and supports (LTSS) by managed care organizations (MCO). MCOs contract with state Medicaid agencies to deliver LTSS to Medicaid program participants within a specific region or county. Physician, acute care, behavioral health and institutional long-term care (nursing home) services may be combined with long-term care services, depending on how the model is structured.
What is a Managed Care Organization?
A Managed care organization (MCO) is an entity that is under contract with the State and receives a monthly capitation payment to provide a prescribed set of services. A regular Medicaid Health Plan which provides physical and some behavioral health services is one type of MCO. Others include Prepaid Inpatient Health Plans (PIHPs) or Prepaid Ambulatory Health Plans (PAHPs). The Centers for Medicare and Medicaid Services defines an MCO as follows:
A Federally qualified HMO that meets CMS’ advance directives requirements for beneficiaries, or
Any public or private entity that meets the advance directives requirements and is determined by the Secretary to also meet the following conditions:
(i) Makes the services it provides to its Medicaid enrollees as accessible (in terms of timeliness, amount, duration, and scope) as those services are to other Medicaid beneficiaries within the area served by the entity.
(ii) Meets federal solvency standards whereby “…insolvency is adequate to ensure that its Medicaid enrollees will not be liable for the MCO's, PIHP's, or PAHP's debts if the entity becomes insolvent.”
How does MLTSS benefit participants?
Managed care organizations work with program participants to develop a care plan to determine the LTSS necessary to meet the individual’s care needs, preferences and goals. MCO’s then coordinate the delivery of those LTSS for the program participant. Services may be provided in the participant’s home, community residence, assisted living home or a nursing home. If an individual relocates to another MCO’s service area, the MCO works with the new service provider to ensure uninterrupted service deliveries.
What services are provided under Managed Long-term Services and Supports (MLTSS)?
MLTSS programs provide service needs from complex-care to assistance with every day activities of daily living. Following are some of the services provided under Medicaid long-term services and supports:
- Care Coordination
- Chore Services (services to maintain a clean living environment)
- Community Living Supports (promote participation in the community)
- Home Delivered Meals
- Home Modifications
- Nursing Services
- Personal Emergency Response Systems
- Respite Services
Physician, acute care, behavioral health and institutional long-term care (nursing home) services may be combined with long-term care services, depending on how the model is structured.
Primary Care services may also be available under MLTSS. Primary care is defined as “… all health care services and laboratory services customarily furnished by or through a general practitioner, family physician, internal medicine physician, obstetrician/gynecologist, pediatrician, or other licensed practitioner as authorized by the State Medicaid program, to the extent the furnishing of those services is legally authorized in the State in which the practitioner furnishes them.”
What Michigan Medicaid programs provide Managed Long-term Services and Supports?
The following Medicaid programs provide long-term services and supports: MI Health Link, the Program of All-Inclusive Care for the Elderly (PACE) and MI Choice Home and Community-based Services.
Will Michigan expand managed long-term services and supports in other Michigan health assistance programs?
The Michigan Department of Health and Human Services was asked to explore the implementation of managed long-term services and supports for other state programs that provide these services. The department is reviewing managed long-term services and supports' best practices in other states to see how Michigan may further the department’s goals in strengthening care coordination, expanding care in the community, promoting person-centeredness, self-determination and informed consumer choice in our programs.
Will participants of programs that become managed care programs lose their services?
If you are a participant of a program that changes its service delivery system to a managed care organization, you will continue to receive the services outlined in your Plan of Care. The change for participants will be that instead of multiple providers delivering your services, those services will be paid for, managed and coordinated by a singular managed care organization that operates in your area.
Will participants of a program that becomes a managed care program be allowed to opt out of the managed care delivery of services?
Whether or not individuals are required to receive services through a managed care organization will depend on the model that is adopted by the state. Some models mandate managed care enrollment and do not allow people who receive services to opt out and receive services on a fee-for-service basis. Models that require managed care enrollment generally offer a choice of two or more plans.