All five states require the MCOs to submit formal quality assurance and improvement (QA/I) plans prior to program implementation. For the most part, MCOs cover the PD-MLTSS within the broader scope of their overall QA/I plans. The following information is also reported in Appendix B, Table B3: PD-MLTSS Quality Monitoring.
Only Tennessee has specific performance indicators for PD-MLTSS: Four out of the five states did not report specific performance indicators (Tennessee was the sole exception). In addition to enrollment targets, Tennessee also requires MCOs to provide information on number of PD-MLTSS members with a representative, service utilization by type of service, number of referrals to FMS, and number of members who withdraw from PD-MLTSS (see Appendix C, Tennessee Enrollment Targets and PD-MLTSS Performance Measures, for Tennessee's full list of performance indicators).
MCO monitoring of PD-MLTSS services varied across the five states: Arizona, Massachusetts, and Texas reported they monitor participants who opt for PD-MLTSS in the same manner they monitor members in MLTSS. Tennessee, however, uses technology to ensure PD-MLTSS compliance and quality for all home-based services and supports. The Tennessee MCO described the Tennessee Electronic Visit Verification (EVV) system as being very robust in tracking when workers arrive and depart and which tasks they performed. If the worker does not arrive within one hour of his or her scheduled time, the MCO service coordinator is notified immediately and the worker's timesheet is suspended. Some exceptions are provided, but the flexibility is typically limited to a four-hour window. Other Tennessee stakeholders noted that the EVV sometimes creates more work for the member and FMS agency as the worker and member may have made alternative service arrangements that did not correspond to the EVV schedule. As one stakeholder commented, the EVV is not set up for participant direction in the sense that every service needs to be scheduled at a specific day and hour. Because the EVV notifies the FMS when the worker visit is completed, thus initiating the process for worker reimbursement, the Tennessee MCO reported that the EVV is beneficial in that it reduces the need to contact the member and verifies service delivery.
All states report having structured opportunities for participant input: Respondents from the states and the MCOs indicated a number of structured ways they seek participant input. All reported using member satisfaction surveys to gauge plan performance. However, none reported that their survey contained PD-MLTSS specific questions. All of the state respondents reported having an MLTSS advisory council and some states (Arizona and New Mexico) encourage MCOs to have their own MLTSS advisory councils. With the exception of New Mexico, none of the advisory councils are specifically focused on PD-MLTSS. In addition to advisory councils, Arizona, New Mexico, and Texas reported the use of community forums or "town meetings" as another avenue to solicit member input.