Step 3: Compare Models

Guidance for choosing an LTSS model.

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

Issue Date: June 26, 2016

It's time to begin the process of choosing the right LTSS model for your community. In this step, you'll examine the options available to you. In Step 4, you will continue the process by figuring out how a certain LTSS model would fit within your community.

LTSS programs follow one of these main models:

Home- and Community-Based Services: individualized care delivered at home or in community settings
Facility-Based Services: care provided in institutions, such as assisted living residences, adult family homes, or nursing homes

Financing and the extent of tribal involvement in LTSS delivery are important to consider at this stage, since these elements are different between the two models.

Financial Considerations

Financing and reimbursement options for LTSS are different from state to state. Plus, the program models may have different reimbursement opportunities available under your state's Medicaid programs.

See LTSS Financing for more information on:

Creating a budget and a financing plan
The benefits and challenges of different funding sources
A step-by-step guide to working with your state
100% FMAP: A potential reimbursement opportunity that can benefit both your tribe and state
The reimbursement process and the many reimbursement rates available

Level of Tribal Involvement

Tribes can assist LTSS programs in many ways, including executive and legislative support, governance, program management, and support of related programs. Different LTSS models require different levels and types of tribal involvement. Consider how your tribe can support your LTSS program by looking at these factors:

Direct and contract services
Management structure
Costs and revenue sources
Number of people served
Program sustainability

See Tribal Involvement for more information on how your tribal government can be involved.

After exploring the available LTSS models, it is time to decide which model makes sense for your community. Proceed to Step 4.

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