LTSS Roadmap Financing Overview
Guidance for the LTSS Roadmap planning model, which can guide communities through the planning process if they need to establish long-term services and supports or improve its current program. This module provides a financial overview of the program.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 03, 2016
LTSS financing and reimbursement is a complex topic that varies greatly from State to State. Materials here can inform you about general considerations and alert you to topics that may arise in conversations with your State about reimbursement. LTSS financing sections include:
Steps for LTSS Programs
Where should you start? See what revenues and expenses contribute to the budget of an example LTSS program. Examine financial performance targets, the role of different revenue sources, and a break-even analysis to determine how many patients your program needs to serve.
Go to Steps for LTSS Programs now >
Who Pays for LTSS?
Many different sources can contribute to LTSS programs. Examine the pros and cons of common payers for tribal LTSS services: Medicaid, Medicare, IHS, private insurance, tribal support, and grants.
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Working With Your State
A step-by-step guide on discussing remibursement processes with your State, inclduing further resources for research for programs planning for LTSS funding. This guide is based on tribal program experiences.
See the step-by-step guide on Working With Your State now>
100% FMAP - Educate Your State
If your state secures 100% FMAP for services provided in tribal facilities, it can make negotiating an enhanced reimbursement rate easier. This page explains the basics of FMAP, and why it is a win-win situation for states and tribes.
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Understand the Reimbursement Process
Although many different types of reimbursement exist, these definitions and discussion can help tribal programs begin to understand the many reimbursement rates that may be available.
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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.