Performance Measures in MLTSS Programs: Research Brief. Introduction


As states move their Medicaid populations with long-term services and supports (LTSS) needs from fee-for-service arrangements into managed care environments, they are increasingly interested in performance measures that are most appropriate for these populations. This Brief provides an overview of the performance measures that some of the more established managed LTSS (MLTSS) programs are using to monitor the services provided to beneficiaries and to improve overall quality in MLTSS.1

Regulations that govern Medicaid managed care2 as well as the Centers for Medicare and Medicaid Services' (CMS's) recent guidance to states on the essential elements of an MLTSS program3 both reference the state's use of performance measures for oversight and quality improvement activities. In addition, many programs must report Medicaid 1915(c) home and community-based services (HCBS) waiver performance measures because these programs operate "combo" waivers which pair a 1915(c) HCBS waiver authority with a 1915(a) or (b) managed care waiver authority. These performance measures must demonstrate that the state meets the 1915(c) assurances federal law requires, several of which are directly related to quality. In the last few years, there has also been a trend for CMS to require performance measures responsive to the 1915(c) assurance for MLTSS programs using the 1115 demonstration waiver authority, particularly for those programs moving populations served under a 1915(c) into an 1115 waiver.4

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"PerfMeaRB.pdf" (pdf, 72.83Kb)

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