Long-Term Services and Supports: A Primer for Case Managers: Part 1

Area of Science:

• Healthcare policy
• Gerontology
• Case management

Background:

• Centers for Medicare & Medicaid Services (CMS) expanded Medicare Advantage benefits in 2019.
• This expansion includes nonmedical home services, significantly altering the Long-Term Services and Supports (LTSS) landscape.
• Understanding LTSS is crucial for vulnerable populations and care continuity.

Purpose of the Study:

• To describe Long-Term Services and Supports (LTSS).
• To outline the regulatory and accreditation landscape of LTSS.
• To emphasize the importance of care continuity within LTSS.

Main Methods:

• This article is a two-part series.
• It describes the traditional demographic and healthcare footprint of LTSS.
• It also covers quality measurement, outcomes, and regulatory aspects.

Main Results:

• Medicare's recognition of services historically influences managed health plans and commercial insurance.
• Case managers need to be proficient in LTSS terminology and CMS changes.
• These changes impact case management practice across the care continuum.

Conclusions:

• Professional case managers must understand LTSS, particularly concerning care transitions.
• Familiarity with LTSS is essential for ensuring continuity of healthcare services for vulnerable clients.
• The CMS changes necessitate an updated understanding of LTSS for effective case management.