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LTSS Roadmap - Step 4: Select a Model

Guidance for the LTSS roadmap planning model specific to step 4: selecting a model.

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: August 03, 2016

Important considerations in the selection process include the impact, required resources, and sustainability and cost-effectiveness of each model.

Impact

  • Are specific, identified LTSS community needs being addressed by the model?

Required Resources (Non-Financial)

  • Based on best practices and state regulations does your Tribe have sufficient human and technical capacity to support the model? These could include personnel with necessary expertise and technical support like broadband access, electronic records, cell phones, diagnostic and treatment equipment.
  • What are the components for the model?
    • Licensure
    • Insurance
    • Building (construction, rent, operational costs, maintenance, etc.)
    • Equipment
    • Personnel (required staffing ratios, training, etc.)
    • Staff housing
  • What are the State’s policies regarding LTSS services and reimbursement? (See State resources to learn more.)
    • Quality of care standards
    • Reimbursement
      • Which services are reimbursable under the State Medicaid plan?
      • Which services are reimbursable under the State Medicaid waiver?
      • How are services authorized under the State Medicaid plan?
      • What are the requirements to contract for services?
      • What is the billing process for the model chosen?
  • How does the model compare to the alternatives, in terms of cost to level of care provided?

Sustainability and Cost Effectiveness

  • Do the data gathered in the needs assessment predict a sufficient volume of users to sustain the chosen LTSS model?
  • How does the model compare to the alternatives, in terms of cost to level of care provided?

Selecting the most appropriate LTSS model requires a careful consideration of these factors and more. A helpful tool in conducting this systematic analysis is the SWOT analysis.

Conducting a SWOT Analysis

“SWOT” is an acronym that stands for Strengths, Weaknesses, Opportunities, and Threats. Strengths and weaknesses are internal factors that you and your Tribe have control over. Opportunities and threats are external factors, which exist in the National, State, or community environment and may affect your LTSS system, but which are outside of your control.

Examples:

  • Strength: a physician in your tribal program is a trained geriatrician (internal)
  • Weakness: some medical staff are not qualified to bill Medicaid (internal)
  • Opportunity: a nearby tribal college is planning on creating a HCBS program (external)
  • Threat: State government is considering cutting Medicaid funding for LTSS (external)

The purpose of the LTSS SWOT analysis is to help Tribes, tribal health administrators, and tribal LTSS program administrators identify internal and external factors and plan for them appropriately. A SWOT analysis can be useful at many points throughout the LTSS planning and implementation process.

Sample SWOT matrix

 

4 Steps of a SWOT Analysis

  • Step 1: Convene meeting of individuals knowledgeable about LTSS, health care, elder care, and Medicaid services.
  • Step 2: Create a list of strengths, weaknesses, opportunities, and threats for your LTSS project.
  • Step 3: Review and discuss the items in each of the four categories and reassign items to the appropriate categories if needed.
  • Step 4: Develop action items that correspond to each component of the SWOT matrix.
    • Strengths: How can we leverage each strength to expand/establish LTSS?
    • Weaknesses: How can we address and correct these weaknesses?
    • Opportunities: How can we capitalize on these opportunities?
    • Threats: How can we mitigate the risks associated with each of these threats?

When you have selected an appropriate LTSS model, you are ready to begin a collaborative planning process to determine how to implement this model in your community.

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.