TABLE OF CONTENTS
CHOICE AND CONTROL
Advocacy Assistance from Managed Care Organizations
Appeals and Grievances Initiation
Appeals and Grievances Procedure
Civil Rights and Cultural Competence
Communication to Consumers
Member Initiated Disenrollment
Authorization of Services
Health Services and Supplies
Personal Care Services
Requirements for Home and Community-Based Services
Transportation and Other
ABOUT THE MLTSS LIBRARY
Across the country, the management of Long Term Services and Supports that are funded by Medicaid is being shifted to Managed Care Organizations. Managed Long Term Services and Supports (MLTSS) is impacting how 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 and implemented, and how the plans and states are held accountable. The details – while complex and often difficult to grasp – really matter.
Justice in Aging’s Advocate’s Library of Managed Long-Term Services and Supports Contract Provisions is a resource that can help advocates ensure that states and plans get the details right. MLTSS program details – including on such important topics as beneficiary protections – should be fully fleshed out in the contracts states enter into with Managed Care Organizations. Our online tool summarizes existing MLTSS contract provisions by topic, and offers page number citations for each cited provision. Topics covered are included in the Table of Contents to the left.
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, Justice in Aging 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.