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LTSS Roadmap - Working with your State

Guidance for the LTSS roadmap planning model providing information to community officials and organizers in successfully working with your state.

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

Issue Date: August 03, 2016

These steps offer general guidance on working with your state for LTSS reimbursement. This list is based on the experiences of successful tribal LTSS programs, but these steps are only meant to provide a general guide. Your situation may be very different—especially if your state contracts with a managed care organization (MCO).

Steps to Establishing Financing

Include LTSS funding in IHS compact

Add LTSS services to your IHS funding agreement. Only services in your funding agreement are eligible for 100% FMAP. 100% FMAP is important for securing an enhanced reimbursement rate.
- Changes to the Indian Health Care Improvement Act make this easier to do. Learn more about IHCIA and LTSS.
- Learn about 100% FMAP and how your state can get it

Identify LTSS covered by your State under waivers and State Medicaid plan

Knowledge is power! Prior to meeting with State representatives, do the research to determine LTSS covered under State waivers and the State Medicaid Plan.
Use these resources:

Meet with State Department of Health representatives

Find your State agency contacts on the State Resources Map.
Consider identifying a technical service liaison - someone from the tribe who can serve as a knowledgeable connection between the tribal and state governments and help with communication.
Work to establish a shared vocabulary with your State representatives. Some terms can mean different things to different audiences.
Explain the benefits to the State and the Tribe of 100% FMAP and the enhanced reimbursement rate.
- Resources for rates and negotiations
Gather and present data on the impact of a change to 100% FMAP—show the increase in Federal revenue and the potential cost savings to the State.
- Refer to Step 1 – Needs Assessment for ideas on data sources and collections methods
Meet with financial experts and policy analysts first. Once they understand the benefits of certain reimbursement rates, they can assist you in other negotiations.
CMS representatives may not be needed in these meetings unless the State needs further clarification on Federal reimbursement issues; if the State already understands the advantages of 100% FMAP, CMS input may not be necessary.
Keep careful records of discussions and decisions. Changes in administration (State or Tribe) can mean that new people will join the discussion.

Explore state reimbursement options

Reimbursement rates and how they are calculated are different in every state, depending on your state Medicaid program and what type of facility or program your LTSS program qualifies as.
- Learn about revenue sources for LTSS
- Learn about different reimbursement rates
Make sure you've explored 100% FMAP with your state and opportunities it could create for your LTSS program.
- View the negotiation toolkit, with strategies and messages

Learn about 100% FMAP next. >

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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.