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Overview of Authorities

Table 5.A provides a summary of the authorities states may use to implement MLTSS programs. In general, you will need to select a managed care authority from the blue section of the chart and combine it with one or more of the LTSS authorities in the yellow section. If you want to include Medicare services in your program, you will also consider an authority from the pink section.

Table 5.a Thumbnail
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In this section we will describe in greater detail the following topics:

  • With a few exceptions, managed care authorities do not address services. Managed care authorities allow you to enroll beneficiaries into a managed care service delivery system, which typically includes a defined network of providers and a capitated payment system.

  • Your program may include LTSS service that is authorized as a Medicaid service. These include mandatory services that all states offer, such as nursing home and home health; optional services that states may offer, such as personal care services and targeted case management; and home- and community-based waiver services offered under Section 1915(c).

  • Because many LTSS consumers are dually enrolled in Medicare and Medicaid, you may consider a model that integrates LTSS and other Medicaid-funded services with primary, acute and other Medicare-funded services. The authorities in the pink section offer options for designing integrated programs for Medicare-Medicaid enrollees.

  • The final topic provides examples of how you can concurrently use LTSS and managed care authorities concurrently to achieve the program features you want in your state.

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