Quality in Managed Long-Term Services and Supports Programs. F. Member Oversight

11/01/2013

"Stakeholder engagement", inclusive of program oversight, is considered a key element in CMS' guidance document. Moving forward, CMS expects states to involve stakeholders, including members, in program evaluation and monitoring. CMS also expects states to require MCOs to convene member advisory committees to provide feedback on MCO MLTSS operations. We were therefore interested in learning how the established MLTSS programs engage members in monitoring and broader program oversight.

In Michigan, members sit on a quality committee and in North Carolina and Texas they have seats on advisory committees. Five programs require advisory committees or state staff to elicit input from members as part of an MCO's annual review or periodically through member focus groups. Three programs require MCOs to engage members either by having them serve on the MCOs' governing board (Wisconsin), or by having seats on the MCOs' Advisory and/or Quality Committees (Pennsylvania, Tennessee). Minnesota requires that each MCO have a Member Advisory Committee and that it meet regularly. Tennessee is unique in that it requires each MCO to have at least 51% of the seats on their Advisory Group be comprised of members or their authorized representatives.

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