Learn more about our Partnership for Wellness & Resilience
What are Long Term Services & Supports (LTSS)?
Millions of children, adults, and seniors living with disabilities in the US need long-term care services and supports. These services range on a continuum from an institutional level of care to home- and community-based services and supports. Medicaid is the primary payer across the nation for such services, which comprise over 20% of Federal and State Medicaid spending.
https://www.medicaid.gov/medicaid/long-term-services-supports/index.html
What are the goals of Home and Community Based Services (HCBS)?
According to Medicaid.gov:
Home and community based services (HCBS) provide opportunities for Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings. These programs serve a variety of targeted populations groups, such as people with intellectual or developmental disabilities, physical disabilities, and/or mental illnesses.
The Centers for Medicare & Medicaid Services (CMS) is working in partnership with states, consumers and advocates, providers and other stakeholders to create a sustainable, person-driven long-term support system in which people with disabilities and chronic conditions have choice, control and access to a full array of quality services that assure optimal outcomes, such as independence, health and quality of life.
The programs and partnerships contained in this section are aimed at achieving a system that is:
Person-driven: The system affords older people, people with disabilities and/or chronic illness the opportunity to decide where and with whom they live, to have control over the services they receive and who provides the services, to work and earn money, and to include friends and supports to help them participate in community life.
Inclusive: The system encourages and supports people to live where they want to live with access to a full array of quality services and supports in the community.
Effective and accountable: The system offers high quality services that improve quality of life. Accountability and responsibility is shared between public and private partners and includes personal accountability and planning for long-term care needs, including greater use and awareness of private sources of funding.
Sustainable and efficient: The system achieves economy and efficiency by coordinating and managing a package of services paid that are appropriate for the beneficiary and paid for by the appropriate party.
Coordinated and transparent: The system coordinates services from various funding streams to provide a coordinated, seamless package of supports, and makes effective use of health information technology to provide transparent information to consumers, providers and payers.
Culturally competent: The system provides accessible information and services that take into account people's cultural and linguistic needs.
https://www.medicaid.gov/medicaid/long-term-services-supports/index.html
Who receives LTSS?
LTSS & HCBS are provided to two populations that are determined by the 1147 Assessment:
Individuals who meet an institutional level of care requirement (nursing facility level of care; NF LOC)
Individuals who are assessed to be "at risk" of deteriorating to institutional level of care (at risk)
What is the Objective for the Demonstration?
To improve health outcomes for Medicaid beneficiaries living with disabilities.
Primary Drivers
Better quality of life for members living with disabilities
Medical needs are met adequately
Continued participation in daily life and community
Maintenance of a healthy lifestyle
Secondary Drivers
Skilled and culturally appropriate provision of Home and Community Based Services
Benefits of community integration
Safety and accessibility of the built environment
Beneficiary's health literacy and communication skills
Evaluation Aims
Compare the population receiving services in the home and/or community with the population receiving institutional care;
Investigate subgroup differences in health outcomes and total cost of care among Home and Community Based Services users; and
Investigate subgroup differences in health outcomes and total cost of care among the at risk population
Research Questions
Does HCBS slow the deterioration of health as reflected in the level of care among individuals meeting NF LOC criteria?
Does length of time to enter a nursing home, patient-reported health outcomes (PROs), and total cost of care vary depending on a variety of client characteristics among individuals meeting NF LOC criteria and receiving HCBS services?
Does length of time to enter a nursing home, PROs, and total cost of care vary depending on a variety of client characteristics among the at-risk population?
Logic Model
LTSS & HCBS Resources
Your Right to a Community Life
https://laddinc.net/wp-content/uploads/2018/09/HCBS-Your-Right-to-a-Community-Life.pdf