LTSS Roadmap - Step 3: Compare Models
Guidance for the LTSS roadmap planning model specific to step 3: comparing models.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 03, 2016
LTSS programs are based on two primary models: Home and Community Based Services and Facility Based Services. Each model has benefits and challenges, requiring different levels and types of tribal involvement, and each program can interact differently with State Medicaid programs for reimbursement. Explore this section to learn about these program and policy details.
Models
- Home and Community Based Services (HCBS) - individualized care delivered in the home and in community settings.
- Facility-Based Services - care provided in institutions such as assisted living residences, adult family homes, and nursing homes.
Financial Considerations
LTSS financing and reimbursement is a complex topic that varies from State to State. This section includes:
- Steps for LTSS Programs - learn where to begin with making a budget and planning for financing
- Who Pays for LTSS? - understand the pros and cons of various funding sources
- Working With Your State - a step-by-step guide based on tribal program experiences
- 100% FMAP - Educate Your State - talk with your State about special reimbursement opportunities for care provided through IHS and tribal programs
- Understand the Reimbursement Process - understand the many reimbursement rates available
Learn more about LTSS financing options for tribal programs.
Level of Tribal Involvement
Tribes are engaged at multiple levels including executive and legislative support, governance, and management of the programs.
Based on the LTSS model you select, determine the Tribe’s role and level of involvement in providing or ensuring quality LTSS.
- Elements to assess
- Direct and contract services
- Management structure
- Costs and revenue sources
- Number served
- Sustainability
Examine the levels of tribal involvement in an LTSS system.
After you have explored the available LTSS models and programs, and understand the strengths, challenges, and level of tribal involvement needed for each model, you will be ready to select the LTSS model that best fits your community's needs.
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