Details Matter! Advocate’s Library of Managed Long Term Services and Supports Contract Provisions

A wave of Medicaid Managed Long Term Services (MLTSS) is currently sweeping the country and promising to impact the way care is delivered to millions of seniors and people with disabilities.  Whether this impact is ultimately positive or negative will depend on the details of how these new systems are designed, implemented and held accountable.  The details – while complex and often difficult to grasp – really matter. 

This new resource can help advocates ensure that states and plans get the details right.  MLTSS program details – including on such important topics as beneficiary protections – will be fully fleshed out in the contracts states enter into with Managed Care Organizations (MCOs),  NSCLC’s Advocate’s Library of Managed Long-Term Services and Supports Contract Provisions is an online tool that summarizes existing MLTSS contract provisions by topic along with a page number citation for each cited provision. Topics covered are included in the Table of Contents below.

The library contains over 1,000 citations to current managed care contracts to allow advocates to easily find the original text.  The contracts themselves are also available here – in one place – so that advocates can read the exact contractual language and surrounding provisions.

In developing the Library, NSCLC reviewed the contracts of most of the states that currently provide long-term services and supports (LTSS) through managed care, focusing on those provisions of particular importance to consumers. 

 NSCLC thanks The Retirement Research Foundation the Atlantic Philanthropies and the Skadden Fellowship Foundation for supporting the development of this library.


Table of Contents

Care Planning
Case Management and Care Planning
Person-Centered Care Planning

Choice and Control
Provider Choice and Access
Consumer Responsibilities and Rights in Self-Direction
Requirements in Self-Direction
Training and Oversight in Self-Direction
Stakeholder Involvement

Consumer Rights
Advocacy Assistance from Managed Care Organizations
Appeals and Grievances Initiation
Appeals and Grievances Procedure
Civil Rights and Cultural Competence
Communication to Consumers

Disenrollment Procedure
Involuntary Disenrollment
Member Initiated Disenrollment
Prohibited Disenrollment

Quality Standards

Service Delivery
Authorization of Services
Care Continuity
Health Services and Supplies
Housing Access
Out-of-Home Care
Personal Care Services
Requirements for Home and Community-Based Services
Transportation and Other

Managed Care Organization Subcontracts

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