Managed Long-Term Services and Supports: Assessment, Authorization, Service Planning, and Case Management in State MLTSS Systems

Over the course of the last decade, the United States has seen a significant increase in the use of Managed Long Term Services and Supports (MLTSS) within the Medicaid program. In order to ensure that MLTSS systems deliver high-quality services to people with disabilities and do not involve inadequate or overly medicalized service provision, states adopt certain requirements within their procurement for and contracting with MCOs. These include requirements for how the MCO and its contractors will conduct activities previously undertaken by the state, including the assessment of individual need, service authorization, person-centered planning, and service coordination to LTSS recipients. This report seeks to articulate promising practices for states designing MLTSS frameworks, drawing on existing state MLTSS contract language and the National Quality Forum’s report on HCBS Quality. It includes a review of MLTSS contract language from 19 state programs.