By Michael Lopez
One of the most significant challenges hospitals face in reducing Length of Stay (LOS) for Medicaid patients is obtaining Managed Long Term Services and Support (MLTSS) coverage for patients with continuing care requirements. Many patients awaiting MLTSS coverage are beyond emergent care and the hospital is at that point only receiving reimbursement for custodial care. Obtaining coverage for many of these patients proves to be a lengthy and complex process. The application and approval process are labor-and time-intensive. An approved MLTSS application enables the hospital to discharge the patient to an environment that provides him/her with the appropriate level of care and long-term support.
The MLTSS benefit refers to the long-term care a person is determined to need, coordinated through a Medicaid managed care organization (MCO). MLTSS includes services such as personal care; respite; care management; home and vehicle modifications; home delivered meals; personal emergency response systems; mental health and addiction services; assisted living; community residential services; and nursing home care. MLTSS provides comprehensive services and support, whether a patient lives at home, in an assisted living facility, in community residential services or in a nursing home.
Many acute care facilities are challenged by the MLTSS applications process. The application review process requires the gathering of historical patient financial documentation (seven-year look back) to complete the application process. After obtaining the necessary documentation, all of the information needs to be reviewed with the patient and/or family to determine if there may be any potential application approval roadblocks. In many facilities, the responsibility for facilitating this process is shared between the Social Work and Case Management Departments, often with minimal coordination of effort or time to assist patients in completing the applications.
Employing dedicated, experienced resources to determine MLTSS eligibility to complete the application and navigate the application process can provide a significant return on investment. Dedicated resources can assist case management with post-discharge planning, allowing the hospital to discharge their patents to the appropriate level of care and minimize length of stay. With outside assistance for MLTSS-eligible patients, facilities can help get qualified patients to the appropriate setting for their care while reducing their length of stay.
About the author: Michael Lopez is an Eligibility Manager for Charity Care and Medicaid programs for CBIZ KA Consulting Services, LLC, (CBIZ) where he is responsible for compliance of state regulations and overseeing the day-to-day policies and procedures of the eligibility department. Michael can be contacted at [email protected].
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