Long-Term Services and Supports: A Primer for Case Managers: Part 2

Area of Science:

• Health Services Research
• Gerontology
• Public Health Policy

Background:

• Medicare Advantage (MA) plans can offer nonmedical home services starting in 2019.
• This policy change significantly impacts the Long-Term Services and Supports (LTSS) landscape.
• Understanding LTSS is crucial for case management across the care continuum.

Purpose of the Study:

• To describe the Long-Term Services and Supports (LTSS) landscape.
• To analyze the regulatory and accreditation environment for LTSS.
• To highlight the importance of care continuity for individuals receiving LTSS.

Main Methods:

• This is a descriptive, 2-part article.
• It examines the traditional demographic and healthcare footprint of LTSS.
• It reviews quality measurement, outcomes, and regulatory aspects of LTSS.

Main Results:

• The Centers for Medicare & Medicaid Services (CMS) initiated a significant policy change in 2019.
• MA plans are now permitted to offer additional benefits for nonmedical home services.
• This expansion affects the provision and integration of LTSS.

Conclusions:

• The recognition of services by Medicare often leads to adoption by managed care and commercial insurers.
• Professional case managers need to be knowledgeable about LTSS and CMS policy changes.
• Understanding LTSS is vital for ensuring seamless care transitions and continuity for vulnerable populations.