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Covered Services

Key Considerations

MLTSS covered services. Based on your state’s goals for an MLTSS program, and your target population’s current use of LTSS, your covered services may include both home and community-based services, such as personal care and employment services, as well as institutional-based services, such as nursing facility and ICF/MR services.  In essence, you can offer anything you are offering in your traditional program in an MLTSS program.  What you choose to include should be based on the needs of the target group.  Leaving out key services (and continuing to have them reimbursed on an FFS basis) has implications for potential cost shifting.  See the Financial Incentives section for more discussion of this issue.

Value-added services. An advantage of MLTSS is that managed care authorities allow you to work with contractors to add additional benefits, such as eyeglasses, home modifications, or employment services that are otherwise not included in the state plan. These benefits may be offered either in lieu of state plan services or as a way to redistribute program savings. For more information about the mechanics of the authorities, see the managed care authorities section in Federal Authorities.

Click the worksheet for key considerations related to Covered Services. Worksheet for Covered Services



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